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CPT code 28490: Toe fracture care, without manipulation2026 Medicare rate & RVUs in Queens, NY

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 Queens, NY, Medicare pays $184.51 for 28490 in the office and $153.32 when it’s performed in a hospital or facility.

$184.51Office (non-facility)
$153.32Hospital or facility
+16.3%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 Queens, NY
  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 Queens, NY 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. Queens, NY pays $184.51. The RVUs are the same everywhere; the geographic indexes change the dollars.

28490 in Queens, NY vs other payment areas
  1. Queens, NY · this page$184.51
  2. Manhattan, NY · New York$183.03−$1.48
  3. NYC suburbs and Long Island, NY · New York$187.67+$3.16
  4. Poughkeepsie and northern NYC suburbs, NY · New York$172.48−$12.03
  5. Rest of New York · New York$151.22−$33.29
  6. Los Angeles, CA · California$179.33−$5.18
  7. Washington, DC area · District of Columbia$181.80−$2.71

Other areas in New York first, then benchmark localities. Bars start at $0.

Every other payment area

28490 in every other Medicare payment locality
Payment localityOfficeFacility
Miami, FLFlorida$172.05$144.58
Chicago, ILIllinois$166.85$140.33
AlaskaAlaska$182.61$154.51
AlabamaAlabama$141.83$118.74
ArkansasArkansas$139.70$117.03
ArizonaArizona$154.27$128.71
Bakersfield, CACalifornia$168.19$139.27
Chico, 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 Queens, NY 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

81

Locality
Queens, NY
Physician work
1.064
Practice expense
1.182
Malpractice
1.442
Office calculation for 28490 in Queens, NY
ComponentRVULocality factorAdjusted
Physician work1.14× 1.0641.2130
Practice expense3.44× 1.1824.0661
Malpractice0.17× 1.4420.2451
Total RVUs5.5242
Conversion factor× 33.4009

Office rate, Queens, NY$184.51

Office: (1.14 × 1.064 + 3.44 × 1.182 + 0.17 × 1.442) × $33.4009 = $184.51

Facility: (1.14 × 1.064 + 2.65 × 1.182 + 0.17 × 1.442) × $33.4009 = $153.32

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, Queens, NY
Same family
28495Toe fracture treatment, great toe, with manipulationGreat toe fracture treatment when manipulation is performed.$226.63
28496Great toe fracture, percutaneous fixation with manipulationGreat toe fracture treatment using percutaneous skeletal fixation with manipulation.$643.06
Used instead
28510Toe fracture care, without manipulationClosed treatment without manipulation for a toe fracture other than the great toe.$151.57
28470Metatarsal fracture care, without manipulation, eachClosed treatment without manipulation for a metatarsal fracture, rather than a great toe fracture.$275.02

How 28490 has changed in Queens, NY

28490 · Office / nonfacility

$184.51

Effective 2026-10-01

The base rate is $15.65 higher than on 2025-10-01, moving from $168.86 to $184.51 (9.3%).

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

    $168.86changed to$184.51

    • 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 1.065 changed to 1.064
    • Practice expense GPCI 1.195 changed to 1.182
    • Malpractice GPCI 1.462 changed to 1.442

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $171.38changed to$168.86

    • 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

    $168.59changed to$171.38

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $175.92changed to$168.59

    • 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 1.061 changed to 1.065
    • Practice expense GPCI 1.212 changed to 1.195
    • Malpractice GPCI 2.061 changed to 1.462

  5. January 1, 2023

    RVU23A

    $179.95changed to$175.92

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 2.86 changed to 2.97
    • Work GPCI 1.056 changed to 1.061
    • Practice expense GPCI 1.228 changed to 1.212
    • Malpractice GPCI 2.661 changed to 2.061

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $178.30changed to$179.95

    • 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

    $178.36changed to$178.30

    • 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 1.054 changed to 1.056
    • Practice expense GPCI 1.214 changed to 1.228
    • Malpractice GPCI 2.391 changed to 2.661

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $176.92changed to$178.36

    • 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 1.052 changed to 1.054
    • Practice expense GPCI 1.200 changed to 1.214
    • Malpractice GPCI 2.121 changed to 2.391

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $180.61changed to$176.92

    • 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

    $178.06changed to$180.61

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 2.84 changed to 2.89
    • Malpractice GPCI 2.151 changed to 2.121

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $178.13changed to$178.06

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 2.85 changed to 2.84
    • Practice expense GPCI 1.199 changed to 1.200
    • Malpractice GPCI 2.181 changed to 2.151

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $179.21changed to$178.13

    • 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

    $178.31changed to$179.21

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $174.66changed to$178.31

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 2.81 changed to 2.86
    • Work GPCI 1.057 changed to 1.052
    • Practice expense GPCI 1.197 changed to 1.199
    • Malpractice GPCI 1.836 changed to 2.181

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $177.65changed to$174.66

    • 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 1.062 changed to 1.057
    • Practice expense GPCI 1.195 changed to 1.197
    • Malpractice GPCI 1.491 changed to 1.836

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $177.65

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$184.51$153.32RVU26D
2026-07-01$184.51$153.32RVU26C
2026-04-01$184.51$153.32RVU26B
2026-01-01$184.51$153.32RVU26A
2025-10-01$168.86$148.37RVU25D
2025-07-01$168.86$148.37RVU25C
2025-04-01$168.86$148.37RVU25B
2025-01-01$168.86$148.37RVU25A
2024-10-01$171.38$150.30RVU24D
2024-07-01$171.38$150.30RVU24C
2024-04-01$171.38$150.30RVU24B
2024-03-09$171.38$150.30RVU24AR
2024-01-01$168.59$147.85RVU24A
2023-10-01$175.92$154.97RVU23D
2023-07-01$175.92$154.97RVU23C
2023-04-01$175.92$154.97RVU23B
2023-01-01$175.92$154.97RVU23A
2022-10-01$179.95$158.28RVU22D
2022-07-01$179.95$158.28RVU22C
2022-04-01$179.95$158.28RVU22B
2022-01-01$179.95$158.28RVU22A
2021-10-01$178.30$155.59RVU21D
2021-07-01$178.30$155.59RVU21C
2021-04-01$178.30$155.59RVU21B
2021-01-01$178.30$155.59RVU21A
2020-10-01$178.36$155.58RVU20D
2020-07-01$178.36$155.58RVU20C
2020-04-01$178.36$155.58RVU20B
2020-01-01$178.36$155.58RVU20A
2019-10-01$176.92$153.13RVU19D
2019-07-01$176.92$153.13RVU19C
2019-04-01$176.92$153.13RVU19B
2019-01-01$176.92$153.13RVU19A
2018-10-01$180.61$153.83RVU18D
2018-07-01$180.61$153.83RVU18C
2018-04-01$180.61$153.83RVU18B
2018-01-01$180.61$153.83RVU18AR1
2017-10-01$178.06$153.08RVU17D
2017-07-01$178.06$153.08RVU17C
2017-04-01$178.06$153.08RVU17B
2017-01-01$178.06$153.08RVU17A
2016-10-01$178.13$153.23RVU16D
2016-07-01$178.13$153.23RVU16C
2016-04-01$178.13$153.23RVU16B
2016-01-01$178.13$153.23RVU16A
2015-10-01$179.21$154.22RVU15D
2015-07-01$179.21$154.22RVU15C
2015-04-01$178.31$153.45RVU15B
2015-01-01$178.31$153.45RVU15A
2014-10-01$174.66$149.79RVU14D
2014-07-01$174.66$149.79RVU14C
2014-04-01$174.66$149.79RVU14B
2014-01-01$174.66$149.79RVU14A
2013-10-01$177.65$151.63RVU13D
2013-07-01$177.65$151.63RVU13C
2013-04-01$177.65$151.63RVU13B
2013-01-01$177.65$151.63RVU13AR

Price 28490 for an earlier date of service

Where the Queens, NY rate applies

Queens, NY is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in New York. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in New York

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 Queens, NYGPCI2026.csv, line 81 (RVU26D)

Open CMS sourceHow we calculate rates

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