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

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 Utah, Medicare pays $186.99 for 28495 in the office and $148.06 when it’s performed in a hospital or facility.

$186.99Office (non-facility)
$148.06Hospital or facility
−4.5%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 Utah
  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 Utah 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. Utah pays $186.99. The RVUs are the same everywhere; the geographic indexes change the dollars.

28495 in Utah vs other payment areas
  1. Utah · this page$186.99
  2. Los Angeles, CA · California$220.30+$33.31
  3. Washington, DC area · District of Columbia$223.34+$36.35
  4. Miami, FL · Florida$211.45+$24.46
  5. Chicago, IL · Illinois$205.43+$18.44
  6. Manhattan, NY · New York$224.90+$37.91
  7. Alaska · Alaska$228.85+$41.86

Other areas in Utah 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 Utah 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

104

Locality
Utah
Physician work
1.000
Practice expense
0.940
Malpractice
0.898
Office calculation for 28495 in Utah
ComponentRVULocality factorAdjusted
Physician work1.64× 1.0001.6400
Practice expense4.02× 0.9403.7788
Malpractice0.20× 0.8980.1796
Total RVUs5.5984
Conversion factor× 33.4009

Office rate, Utah$186.99

Office: (1.64 × 1 + 4.02 × 0.94 + 0.2 × 0.898) × $33.4009 = $186.99

Facility: (1.64 × 1 + 2.78 × 0.94 + 0.2 × 0.898) × $33.4009 = $148.06

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, Utah
Same family
28490Toe fracture care, without manipulationGreat-toe phalanx fracture treatment without manipulation.$151.18
Used instead
28496Great toe fracture, percutaneous fixation with manipulationFor a great-toe fracture treated with manipulation and percutaneous skeletal fixation.$519.68
28505Toe fracture surgery, great toe, open treatmentOpen treatment option for a great-toe phalanx fracture.$641.45

How 28495 has changed in Utah

28495 · Office / nonfacility

$186.99

Effective 2026-10-01

The base rate is $13.16 higher than on 2025-10-01, moving from $173.83 to $186.99 (7.6%).

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

    $173.83changed to$186.99

    • 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
    • Practice expense GPCI 0.933 changed to 0.940
    • Malpractice GPCI 0.930 changed to 0.898

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $176.41changed to$173.83

    • 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

    $173.53changed to$176.41

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $173.27changed to$173.53

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 3.53 changed to 3.69
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.865 changed to 0.930

  5. January 1, 2023

    RVU23A

    $172.75changed to$173.27

    • 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
    • Practice expense GPCI 0.919 changed to 0.926
    • Malpractice GPCI 0.799 changed to 0.865

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $171.42changed to$172.75

    • 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

    $174.96changed to$171.42

    • 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
    • Practice expense GPCI 0.923 changed to 0.919
    • Malpractice GPCI 0.982 changed to 0.799

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $177.35changed to$174.96

    • 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
    • Practice expense GPCI 0.927 changed to 0.923
    • Malpractice GPCI 1.165 changed to 0.982

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $176.82changed to$177.35

    • 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

    $175.39changed to$176.82

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 3.24 changed to 3.26
    • Practice expense GPCI 0.925 changed to 0.927
    • Malpractice GPCI 1.167 changed to 1.165

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $174.64changed to$175.39

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense GPCI 0.922 changed to 0.925
    • Malpractice GPCI 1.169 changed to 1.167

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $177.35changed to$174.64

    • 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

    $176.47changed to$177.35

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $172.27changed to$176.47

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 3.17 changed to 3.29
    • Practice expense GPCI 0.919 changed to 0.922
    • Malpractice GPCI 1.136 changed to 1.169

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $174.67changed to$172.27

    • 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 0.916 changed to 0.919
    • Malpractice GPCI 1.102 changed to 1.136

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $174.67

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$186.99$148.06RVU26D
2026-07-01$186.99$148.06RVU26C
2026-04-01$186.99$148.06RVU26B
2026-01-01$186.99$148.06RVU26A
2025-10-01$173.83$145.47RVU25D
2025-07-01$173.83$145.47RVU25C
2025-04-01$173.83$145.47RVU25B
2025-01-01$173.83$145.47RVU25A
2024-10-01$176.41$147.21RVU24D
2024-07-01$176.41$147.21RVU24C
2024-04-01$176.41$147.21RVU24B
2024-03-09$176.41$147.21RVU24AR
2024-01-01$173.53$144.81RVU24A
2023-10-01$173.27$145.03RVU23D
2023-07-01$173.27$145.03RVU23C
2023-04-01$173.27$145.03RVU23B
2023-01-01$173.27$145.03RVU23A
2022-10-01$172.75$144.13RVU22D
2022-07-01$172.75$144.13RVU22C
2022-04-01$172.75$144.13RVU22B
2022-01-01$172.75$144.13RVU22A
2021-10-01$171.42$142.56RVU21D
2021-07-01$171.42$142.56RVU21C
2021-04-01$171.42$142.56RVU21B
2021-01-01$171.42$142.56RVU21A
2020-10-01$174.96$146.64RVU20D
2020-07-01$174.96$146.64RVU20C
2020-04-01$174.96$146.64RVU20B
2020-01-01$174.96$146.64RVU20A
2019-10-01$177.35$148.95RVU19D
2019-07-01$177.35$148.95RVU19C
2019-04-01$177.35$148.95RVU19B
2019-01-01$177.35$148.95RVU19A
2018-10-01$176.82$148.79RVU18D
2018-07-01$176.82$148.79RVU18C
2018-04-01$176.82$148.79RVU18B
2018-01-01$176.82$148.79RVU18AR1
2017-10-01$175.39$148.83RVU17D
2017-07-01$175.39$148.83RVU17C
2017-04-01$175.39$148.83RVU17B
2017-01-01$175.39$148.83RVU17A
2016-10-01$174.64$147.90RVU16D
2016-07-01$174.64$147.90RVU16C
2016-04-01$174.64$147.90RVU16B
2016-01-01$174.64$147.90RVU16A
2015-10-01$177.35$150.51RVU15D
2015-07-01$177.35$150.51RVU15C
2015-04-01$176.47$149.76RVU15B
2015-01-01$176.47$149.76RVU15A
2014-10-01$172.27$146.27RVU14D
2014-07-01$172.27$146.27RVU14C
2014-04-01$172.27$146.27RVU14B
2014-01-01$172.27$146.27RVU14A
2013-10-01$174.67$147.24RVU13D
2013-07-01$174.67$147.24RVU13C
2013-04-01$174.67$147.24RVU13B
2013-01-01$174.67$147.24RVU13AR

Price 28495 for an earlier date of service

Where the Utah rate applies

Utah is a Medicare payment area, not a city. Our Census mapping connects it to 334 cities and communities in Utah. Some span more than one payment area; confirm with the service ZIP.

  • Alpine
  • Alta
  • Altamont
  • Alton
  • Amalga
  • American Fork
  • Aneth
  • Annabella

Browse all communities in Utah

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 UtahGPCI2026.csv, line 104 (RVU26D)

Open CMS sourceHow we calculate rates

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