CPT code 28495: Toe fracture treatment, great toe, with manipulation2026 Medicare rate & RVUs

Medicare pays $195.73 for 28495 nationally in the office and $154.31 in a hospital or facility. Local office rates run $173.56–$258.00.

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

What 28495 covers

Code 28495 represents closed treatment of a fracture in a great-toe phalanx when the clinician manipulates the fracture to restore alignment. The provider may use manual reduction and then immobilize the toe, such as with taping, a rigid-soled shoe, or a splint. Typical cases include a displaced hallux phalanx fracture managed without an incision or percutaneous hardware. Orthopedic surgeons, podiatrists, and other clinicians qualified to manage fractures may perform this service in an office, emergency department, or facility setting.

Report the code for a great-toe phalanx fracture and document the fracture site and manipulation performed. CMS assigns a 90-day major-surgery global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. CMS does not pay an assistant at surgery for this code; 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.

Where 28495 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

28495 rates by state

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

How the 28495 rate is calculated

Each of 28495’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.

Payment rules and modifiers for 28495

28495 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 50

28495 compared with similar codes

How to choose

28490Toe fracture careWithout manipulation

Both codes treat great-toe phalanx fractures without open exposure. Choose 28495 when the provider manipulates the fracture; 28490 is for treatment without manipulation.

28496Great toe fracturePercutaneous fixation with manipulation

28496 includes percutaneous skeletal fixation with manipulation. Use 28495 for closed treatment with manipulation when that fixation is not performed.

28475Metatarsal fractureClosed reduction, each bone

28475 concerns a metatarsal fracture treated with manipulation, not a phalanx fracture of the great toe.

Codes related to 28495

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

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

Open CMS sourceHow we calculate rates