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CPT code 28490: Toe fracture care, without manipulation2026 Medicare rate & RVUs in Washington, DC area

Reports closed treatment of a great toe fracture managed without manipulation, such as a stable fracture treated with immobilization and follow-up.

CMS RVU26DEffective Oct 1, 2026One payment locality4.8K Medicare services in 2024

In Washington, DC area, Medicare pays $181.80 for 28490 in the office and $150.72 when it’s performed in a hospital or facility.

$181.80Office (non-facility)
$150.72Hospital or facility
+14.6%vs the national office rate ($158.65)

Check a contract rate as a % of Medicare · 28490 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 28490 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Washington, DC area
  2. What 28490 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 28490 covers

This code represents closed treatment of a great toe fracture when the treating clinician manages the fracture without manipulating it to change alignment. It commonly describes care for a stable fracture managed with measures such as buddy taping, a protective shoe, splinting, or casting. Orthopedic surgeons, podiatrists, and other clinicians who assume responsibility for fracture treatment may report it in an office, emergency, or other appropriate setting. A visit that only evaluates the injury before the patient is referred elsewhere is not the same as assuming fracture care.

Document the great toe fracture, the decision to treat it without manipulation, and the treatment plan. CMS assigns a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. For bilateral treatment, modifier 50 is paid at 150%. Assistant-at-surgery services are not paid; co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Washington, DC area compares for 28490

Across 109 of 109 payment localities, the office rate for 28490 runs from $139.70 in Arkansas to $210.99 in San Benito County, CA. Washington, DC area pays $181.80. The RVUs are the same everywhere; the geographic indexes change the dollars.

28490 in Washington, DC area vs other payment areas
  1. Washington, DC area · this page$181.80
  2. Los Angeles, CA · California$179.33−$2.47
  3. Miami, FL · Florida$172.05−$9.75
  4. Chicago, IL · Illinois$166.85−$14.95
  5. Manhattan, NY · New York$183.03+$1.23
  6. Alaska · Alaska$182.61+$0.81
  7. Alabama · Alabama$141.83−$39.97

Other areas in District of Columbia first, then benchmark localities. Bars start at $0.

Every other payment area

28490 in every other Medicare payment locality
Payment localityOfficeFacility
ArkansasArkansas$139.70$117.03
ArizonaArizona$154.27$128.71
Bakersfield, CACalifornia$168.19$139.27
Chico, CACalifornia$167.70$138.78
El Centro, CACalifornia$167.73$138.81
Fresno, CACalifornia$167.70$138.78
Hanford, CACalifornia$167.70$138.78
Madera, CACalifornia$167.70$138.78

28490 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$139.70

$189.35

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
28490 office rate range by state
State / territoryOffice rate rangeLocalities
AK$182.611
AL$141.831
AR$139.701
AZ$154.271
CA$167.70–$210.9929
CO$165.221
CT$169.461
DC$181.801
DE$156.891
FL$156.45–$172.053
GA$147.34–$161.752
GU$172.001
HI$172.001
IA$145.461
ID$146.471
IL$151.85–$166.854
IN$147.351
KS$144.811
KY$145.421
LA$145.20–$152.652
MA$164.20–$181.882
MD$159.95–$181.803
ME$147.32–$155.522
MI$149.39–$158.532
MN$157.991
MO$142.65–$153.153
MS$141.201
MT$158.641
NC$148.911
ND$155.281
NE$146.281
NH$162.661
NJ$171.30–$179.822
NM$150.261
NV$157.821
NY$151.22–$187.675
OH$148.701
OK$145.091
OR$156.51–$170.562
PA$148.92–$165.152
PR$159.831
RI$162.561
SC$149.071
SD$154.881
TN$145.571
TX$147.91–$164.758
UT$151.181
VA$155.03–$181.802
VI$159.831
VT$154.701
WA$163.88–$185.602
WI$149.901
WV$146.051
WY$157.181

See 28490 in every payment locality

How the 28490 rate is calculated

Each of 28490’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 28490

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.14

1.14 RVUs× 1.000 GPCI

Practice expense3.44

3.44 RVUs× 1.000 GPCI

Malpractice0.17

0.17 RVUs× 1.000 GPCI

Adjusted RVUs

4.7500

Conversion factor

$33.4009

Medicare rate

$158.65

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Washington, DC area inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

3,216

Code
28490
Physician work
1.14
Practice expense
3.44
Malpractice
0.17

GPCI2026.csv

39

Locality
Washington, DC area
Physician work
1.054
Practice expense
1.178
Malpractice
1.113
Office calculation for 28490 in Washington, DC area
ComponentRVULocality factorAdjusted
Physician work1.14× 1.0541.2016
Practice expense3.44× 1.1784.0523
Malpractice0.17× 1.1130.1892
Total RVUs5.4431
Conversion factor× 33.4009

Office rate, Washington, DC area$181.80

Office: (1.14 × 1.054 + 3.44 × 1.178 + 0.17 × 1.113) × $33.4009 = $181.80

Facility: (1.14 × 1.054 + 2.65 × 1.178 + 0.17 × 1.113) × $33.4009 = $150.72

Open 28490 in the RVU calculator

Payment rules and modifiers for 28490

28490 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 28490

Toe fracture care, without manipulation

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.69/0.21Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 28490

Toe fracture care, without manipulation

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

28490 without 50 · national office

$158.65

Toe fracture care, without manipulation

28490-50 · Bilateral: 150%

$237.98

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

Codes related to 28490

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 28490
CodeHow it relatesOffice range, Washington, DC area
Same family
28495Toe fracture treatment, great toe, with manipulationGreat toe fracture treatment when manipulation is performed.$223.34
28496Great toe fracture, percutaneous fixation with manipulationGreat toe fracture treatment using percutaneous skeletal fixation with manipulation.$634.96
Used instead
28510Toe fracture care, without manipulationClosed treatment without manipulation for a toe fracture other than the great toe.$149.19
28470Metatarsal fracture care, without manipulation, eachClosed treatment without manipulation for a metatarsal fracture, rather than a great toe fracture.$270.53

How 28490 has changed in Washington, DC area

28490 · Office / nonfacility

$181.80

Effective 2026-10-01

The base rate is $15.07 higher than on 2025-10-01, moving from $166.73 to $181.80 (9.0%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $166.73changed to$181.80

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.17 changed to 1.14
    • Practice expense RVU 3.13 changed to 3.44
    • Malpractice RVU 0.16 changed to 0.17
    • Work GPCI 1.057 changed to 1.054
    • Practice expense GPCI 1.192 changed to 1.178
    • Malpractice GPCI 1.168 changed to 1.113

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $169.20changed to$166.73

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 3.07 changed to 3.13

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $166.44changed to$169.20

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $171.14changed to$166.44

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 2.97 changed to 3.07
    • Malpractice RVU 0.17 changed to 0.16
    • Work GPCI 1.056 changed to 1.057
    • Practice expense GPCI 1.214 changed to 1.192
    • Malpractice GPCI 1.231 changed to 1.168

  5. January 1, 2023

    RVU23A

    $172.62changed to$171.14

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 2.86 changed to 2.97
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.236 changed to 1.214
    • Malpractice GPCI 1.294 changed to 1.231

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $171.85changed to$172.62

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 2.83 changed to 2.86
    • Malpractice RVU 0.15 changed to 0.17

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $172.41changed to$171.85

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 2.74 changed to 2.83
    • Malpractice RVU 0.16 changed to 0.15
    • Work GPCI 1.049 changed to 1.054
    • Practice expense GPCI 1.221 changed to 1.236
    • Malpractice GPCI 1.277 changed to 1.294

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $172.48changed to$172.41

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 2.80 changed to 2.74
    • Malpractice RVU 0.15 changed to 0.16
    • Work GPCI 1.045 changed to 1.049
    • Practice expense GPCI 1.205 changed to 1.221
    • Malpractice GPCI 1.261 changed to 1.277

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $176.19changed to$172.48

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 2.89 changed to 2.80

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $173.67changed to$176.19

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 2.84 changed to 2.89
    • Work GPCI 1.048 changed to 1.045
    • Malpractice GPCI 1.271 changed to 1.261

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $173.86changed to$173.67

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 2.85 changed to 2.84
    • Work GPCI 1.051 changed to 1.048
    • Malpractice GPCI 1.280 changed to 1.271

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $174.92changed to$173.86

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 2.86 changed to 2.85

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $174.05changed to$174.92

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $171.48changed to$174.05

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 2.81 changed to 2.86
    • Work GPCI 1.050 changed to 1.051
    • Practice expense GPCI 1.202 changed to 1.205
    • Malpractice GPCI 1.205 changed to 1.280

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $175.49changed to$171.48

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 3.13 changed to 2.81
    • Malpractice RVU 0.16 changed to 0.15
    • Work GPCI 1.049 changed to 1.050
    • Practice expense GPCI 1.198 changed to 1.202
    • Malpractice GPCI 1.130 changed to 1.205

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $175.49

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$181.80$150.72RVU26D
2026-07-01$181.80$150.72RVU26C
2026-04-01$181.80$150.72RVU26B
2026-01-01$181.80$150.72RVU26A
2025-10-01$166.73$146.30RVU25D
2025-07-01$166.73$146.30RVU25C
2025-04-01$166.73$146.30RVU25B
2025-01-01$166.73$146.30RVU25A
2024-10-01$169.20$148.17RVU24D
2024-07-01$169.20$148.17RVU24C
2024-04-01$169.20$148.17RVU24B
2024-03-09$169.20$148.17RVU24AR
2024-01-01$166.44$145.75RVU24A
2023-10-01$171.14$150.16RVU23D
2023-07-01$171.14$150.16RVU23C
2023-04-01$171.14$150.16RVU23B
2023-01-01$171.14$150.16RVU23A
2022-10-01$172.62$150.81RVU22D
2022-07-01$172.62$150.81RVU22C
2022-04-01$172.62$150.81RVU22B
2022-01-01$172.62$150.81RVU22A
2021-10-01$171.85$149.00RVU21D
2021-07-01$171.85$149.00RVU21C
2021-04-01$171.85$149.00RVU21B
2021-01-01$171.85$149.00RVU21A
2020-10-01$172.41$149.49RVU20D
2020-07-01$172.41$149.49RVU20C
2020-04-01$172.41$149.49RVU20B
2020-01-01$172.41$149.49RVU20A
2019-10-01$172.48$148.59RVU19D
2019-07-01$172.48$148.59RVU19C
2019-04-01$172.48$148.59RVU19B
2019-01-01$172.48$148.59RVU19A
2018-10-01$176.19$149.30RVU18D
2018-07-01$176.19$149.30RVU18C
2018-04-01$176.19$149.30RVU18B
2018-01-01$176.19$149.30RVU18AR1
2017-10-01$173.67$148.58RVU17D
2017-07-01$173.67$148.58RVU17C
2017-04-01$173.67$148.58RVU17B
2017-01-01$173.67$148.58RVU17A
2016-10-01$173.86$148.84RVU16D
2016-07-01$173.86$148.84RVU16C
2016-04-01$173.86$148.84RVU16B
2016-01-01$173.86$148.84RVU16A
2015-10-01$174.92$149.81RVU15D
2015-07-01$174.92$149.81RVU15C
2015-04-01$174.05$149.06RVU15B
2015-01-01$174.05$149.06RVU15A
2014-10-01$171.48$146.50RVU14D
2014-07-01$171.48$146.50RVU14C
2014-04-01$171.48$146.50RVU14B
2014-01-01$171.48$146.50RVU14A
2013-10-01$175.49$149.40RVU13D
2013-07-01$175.49$149.40RVU13C
2013-04-01$175.49$149.40RVU13B
2013-01-01$175.49$149.40RVU13AR

Price 28490 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

  • Washington

Browse all communities in District of Columbia

28490 billing questions

How is 28490 distinguished from 28495?

Use 28490 when the great toe fracture is treated without manipulation. When the clinician manipulates the fracture to alter alignment, consider 28495 instead.

When is 28496 considered instead?

28496 describes percutaneous skeletal fixation of a great toe fracture with manipulation. It is not the code for closed treatment without manipulation.

Does routine fracture follow-up fall within this code's global period?

CMS assigns 28490 a 90-day global period. The day-before preoperative visit and 90 days of related postoperative care are included.

How is treatment of both great toes handled?

CMS identifies this as a bilateral procedure; modifier 50 is paid at 150%. Document treatment of both sides.

Can an assistant, co-surgeon, or surgical team be paid for this service?

CMS applies a statutory restriction to assistant-at-surgery payment. Co-surgeons and team surgery are not permitted for this code.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 28490PPRRVU2026_Oct_nonQPP.csv, line 3,216 (RVU26D)
Geographic factors for Washington, DC areaGPCI2026.csv, line 39 (RVU26D)

Open CMS sourceHow we calculate rates

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