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

Closed reduction and treatment of a great-toe phalanx fracture when the provider manipulates the fracture without open exposure or percutaneous fixation.

CMS RVU26DEffective Oct 1, 2026One payment locality238 Medicare services in 2024

In Delaware, Medicare pays $193.72 for 28495 in the office and $152.80 when it’s performed in a hospital or facility.

$193.72Office (non-facility)
$152.80Hospital or facility
−1.0%vs the national office rate ($195.73)

Check a contract rate as a % of Medicare · 28495 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 28495 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Delaware
  2. What 28495 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 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.

How Delaware compares for 28495

Across 109 of 109 payment localities, the office rate for 28495 runs from $173.56 in Arkansas to $258.00 in San Benito County, CA. Delaware pays $193.72. The RVUs are the same everywhere; the geographic indexes change the dollars.

28495 in Delaware vs other payment areas
  1. Delaware · this page$193.72
  2. Los Angeles, CA · California$220.30+$26.58
  3. Washington, DC area · District of Columbia$223.34+$29.62
  4. Miami, FL · Florida$211.45+$17.73
  5. Chicago, IL · Illinois$205.43+$11.71
  6. Manhattan, NY · New York$224.90+$31.18
  7. Alaska · Alaska$228.85+$35.13

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

Every other payment area

28495 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$176.05$139.81
ArkansasArkansas$173.56$137.98
ArizonaArizona$190.60$150.47
Bakersfield, CACalifornia$207.05$161.66
Chico, CACalifornia$206.45$161.06
El Centro, CACalifornia$206.48$161.09
Fresno, CACalifornia$206.45$161.06
Hanford, CACalifornia$206.45$161.06

28495 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.

$173.56

$232.23

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

View every state and territory as a table
28495 office rate range by state
State / territoryOffice rate rangeLocalities
AK$228.851
AL$176.051
AR$173.561
AZ$190.601
CA$206.45–$258.0029
CO$203.521
CT$208.571
DC$223.341
DE$193.721
FL$193.18–$211.453
GA$182.51–$199.382
GU$211.311
HI$211.311
IA$180.291
ID$181.471
IL$187.81–$205.434
IN$182.491
KS$179.531
KY$180.261
LA$180.01–$188.722
MA$202.37–$223.292
MD$197.34–$223.343
ME$182.46–$192.062
MI$184.91–$195.612
MN$194.921
MO$177.03–$189.303
MS$175.321
MT$195.721
NC$184.321
ND$191.761
NE$181.241
NH$200.401
NJ$210.92–$221.122
NM$185.931
NV$194.751
NY$187.03–$230.345
OH$184.101
OK$179.871
OR$193.21–$209.802
PA$184.35–$203.512
PR$197.111
RI$200.481
SC$184.521
SD$191.291
TN$180.421
TX$183.17–$202.878
UT$186.991
VA$191.48–$223.342
VI$197.111
VT$191.091
WA$201.96–$227.732
WI$185.471
WV$181.021
WY$193.991

See 28495 in every payment locality

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.

How the rate is built · 28495

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.64

1.64 RVUs× 1.000 GPCI

Practice expense4.02

4.02 RVUs× 1.000 GPCI

Malpractice0.20

0.20 RVUs× 1.000 GPCI

Adjusted RVUs

5.8600

Conversion factor

$33.4009

Medicare rate

$195.73

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

The exact Delaware inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

3,217

Code
28495
Physician work
1.64
Practice expense
4.02
Malpractice
0.20

GPCI2026.csv

40

Locality
Delaware
Physician work
1.005
Practice expense
0.988
Malpractice
0.899
Office calculation for 28495 in Delaware
ComponentRVULocality factorAdjusted
Physician work1.64× 1.0051.6482
Practice expense4.02× 0.9883.9718
Malpractice0.20× 0.8990.1798
Total RVUs5.7998
Conversion factor× 33.4009

Office rate, Delaware$193.72

Office: (1.64 × 1.005 + 4.02 × 0.988 + 0.2 × 0.899) × $33.4009 = $193.72

Facility: (1.64 × 1.005 + 2.78 × 0.988 + 0.2 × 0.899) × $33.4009 = $152.80

Open 28495 in the RVU calculator

Payment rules and modifiers for 28495

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

CMS payment indicators · 28495

Toe fracture treatment, great toe, with 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 · 28495

Toe fracture treatment, great toe, with 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

28495 without 50 · national office

$195.73

Toe fracture treatment, great toe, with manipulation

28495-50 · Bilateral: 150%

$293.60

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 28495

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

Codes related to 28495
CodeHow it relatesOffice range, Delaware
Same family
28490Toe fracture care, without manipulationGreat-toe phalanx fracture treatment without manipulation.$156.89
Used instead
28496Great toe fracture, percutaneous fixation with manipulationFor a great-toe fracture treated with manipulation and percutaneous skeletal fixation.$541.75
28505Toe fracture surgery, great toe, open treatmentOpen treatment option for a great-toe phalanx fracture.$661.62

How 28495 has changed in Delaware

28495 · Office / nonfacility

$193.72

Effective 2026-10-01

The base rate is $12.07 higher than on 2025-10-01, moving from $181.65 to $193.72 (6.6%).

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

    $181.65changed to$193.72

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.68 changed to 1.64
    • Practice expense RVU 3.78 changed to 4.02
    • Malpractice RVU 0.18 changed to 0.20
    • Work GPCI 1.009 changed to 1.005
    • Practice expense GPCI 0.992 changed to 0.988
    • Malpractice GPCI 0.949 changed to 0.899

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $184.28changed to$181.65

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 3.69 changed to 3.78
    • Malpractice RVU 0.19 changed to 0.18

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $181.27changed to$184.28

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $183.83changed to$181.27

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 3.53 changed to 3.69
    • Work GPCI 1.007 changed to 1.009
    • Practice expense GPCI 1.007 changed to 0.992
    • Malpractice GPCI 0.938 changed to 0.949

  5. January 1, 2023

    RVU23A

    $186.16changed to$183.83

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 3.43 changed to 3.53
    • Malpractice RVU 0.20 changed to 0.19
    • Work GPCI 1.005 changed to 1.007
    • Practice expense GPCI 1.022 changed to 1.007
    • Malpractice GPCI 0.927 changed to 0.938

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $184.59changed to$186.16

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 3.37 changed to 3.43
    • Malpractice RVU 0.17 changed to 0.20

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $187.03changed to$184.59

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.23 changed to 3.37
    • Malpractice RVU 0.19 changed to 0.17
    • Work GPCI 1.006 changed to 1.005
    • Practice expense GPCI 1.021 changed to 1.022
    • Malpractice GPCI 1.023 changed to 0.927

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $188.32changed to$187.03

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 3.27 changed to 3.23
    • Malpractice RVU 0.18 changed to 0.19
    • Work GPCI 1.007 changed to 1.006
    • Practice expense GPCI 1.019 changed to 1.021
    • Malpractice GPCI 1.119 changed to 1.023

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $187.74changed to$188.32

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 3.26 changed to 3.27

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $187.19changed to$187.74

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 3.24 changed to 3.26
    • Work GPCI 1.010 changed to 1.007
    • Practice expense GPCI 1.025 changed to 1.019
    • Malpractice GPCI 1.101 changed to 1.119

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $187.45changed to$187.19

    • Conversion factor 35.8043 changed to 35.8887
    • Work GPCI 1.012 changed to 1.010
    • Practice expense GPCI 1.031 changed to 1.025
    • Malpractice GPCI 1.083 changed to 1.101

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $190.37changed to$187.45

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 3.29 changed to 3.24
    • Malpractice RVU 0.19 changed to 0.18

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $189.43changed to$190.37

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $184.75changed to$189.43

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 3.17 changed to 3.29
    • Practice expense GPCI 1.038 changed to 1.031
    • Malpractice GPCI 0.878 changed to 1.083

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $187.80changed to$184.75

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 3.53 changed to 3.17
    • Malpractice RVU 0.20 changed to 0.19
    • Practice expense GPCI 1.044 changed to 1.038
    • Malpractice GPCI 0.672 changed to 0.878

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $187.80

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$193.72$152.80RVU26D
2026-07-01$193.72$152.80RVU26C
2026-04-01$193.72$152.80RVU26B
2026-01-01$193.72$152.80RVU26A
2025-10-01$181.65$151.49RVU25D
2025-07-01$181.65$151.49RVU25C
2025-04-01$181.65$151.49RVU25B
2025-01-01$181.65$151.49RVU25A
2024-10-01$184.28$153.24RVU24D
2024-07-01$184.28$153.24RVU24C
2024-04-01$184.28$153.24RVU24B
2024-03-09$184.28$153.24RVU24AR
2024-01-01$181.27$150.74RVU24A
2023-10-01$183.83$153.12RVU23D
2023-07-01$183.83$153.12RVU23C
2023-04-01$183.83$153.12RVU23B
2023-01-01$183.83$153.12RVU23A
2022-10-01$186.16$154.32RVU22D
2022-07-01$186.16$154.32RVU22C
2022-04-01$186.16$154.32RVU22B
2022-01-01$186.16$154.32RVU22A
2021-10-01$184.59$152.49RVU21D
2021-07-01$184.59$152.49RVU21C
2021-04-01$184.59$152.49RVU21B
2021-01-01$184.59$152.49RVU21A
2020-10-01$187.03$155.71RVU20D
2020-07-01$187.03$155.71RVU20C
2020-04-01$187.03$155.71RVU20B
2020-01-01$187.03$155.71RVU20A
2019-10-01$188.32$157.10RVU19D
2019-07-01$188.32$157.10RVU19C
2019-04-01$188.32$157.10RVU19B
2019-01-01$188.32$157.10RVU19A
2018-10-01$187.74$156.93RVU18D
2018-07-01$187.74$156.93RVU18C
2018-04-01$187.74$156.93RVU18B
2018-01-01$187.74$156.93RVU18AR1
2017-10-01$187.19$157.77RVU17D
2017-07-01$187.19$157.77RVU17C
2017-04-01$187.19$157.77RVU17B
2017-01-01$187.19$157.77RVU17A
2016-10-01$187.45$157.55RVU16D
2016-07-01$187.45$157.55RVU16C
2016-04-01$187.45$157.55RVU16B
2016-01-01$187.45$157.55RVU16A
2015-10-01$190.37$160.36RVU15D
2015-07-01$190.37$160.36RVU15C
2015-04-01$189.43$159.57RVU15B
2015-01-01$189.43$159.57RVU15A
2014-10-01$184.75$155.38RVU14D
2014-07-01$184.75$155.38RVU14C
2014-04-01$184.75$155.38RVU14B
2014-01-01$184.75$155.38RVU14A
2013-10-01$187.80$156.55RVU13D
2013-07-01$187.80$156.55RVU13C
2013-04-01$187.80$156.55RVU13B
2013-01-01$187.80$156.55RVU13AR

Price 28495 for an earlier date of service

Where the Delaware rate applies

Delaware is a Medicare payment area, not a city. Our Census mapping connects it to 79 cities and communities in Delaware. Some span more than one payment area; confirm with the service ZIP.

  • Arden
  • Ardencroft
  • Ardentown
  • Bear
  • Bellefonte
  • Bethany Beach
  • Bethel
  • Blades

Browse all communities in Delaware

28495 billing questions

How does 28495 differ from 28490?

28495 is for closed treatment of a great-toe phalanx fracture with manipulation. Use 28490 when the fracture is treated without manipulation.

When is 28496 used instead?

28496 describes percutaneous skeletal fixation of a great-toe phalanx fracture with manipulation. 28495 is the closed-treatment code when percutaneous fixation is not performed.

Are routine related postoperative visits separately reported?

The 90-day global period includes related postoperative care, as well as the day-before preoperative visit.

Can modifier 50 be used when both great toes are treated?

CMS identifies this as a bilateral procedure; bilateral reporting with modifier 50 is paid at 150%.

Can an assistant surgeon or co-surgeon be reported?

CMS does not pay an assistant at surgery for 28495. Co-surgeons and team surgery are not permitted.

Does this code include fractures of the lesser toes?

No. This code is specific to a great-toe phalanx fracture; lesser-toe fractures are reported with codes for other toes.

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 28495PPRRVU2026_Oct_nonQPP.csv, line 3,217 (RVU26D)
Geographic factors for DelawareGPCI2026.csv, line 40 (RVU26D)

Open CMS sourceHow we calculate rates

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