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CPT code 28496: Great toe fracture, percutaneous fixation with manipulation2026 Medicare rate & RVUs in North Carolina

Percutaneous skeletal fixation with manipulation treats a great toe fracture when the fracture requires reduction and pin fixation rather than closed treatment alone.

CMS RVU26DEffective Oct 1, 2026One payment locality81 Medicare services in 2024

In North Carolina, Medicare pays $512.20 for 28496 in the office and $262.59 when it’s performed in a hospital or facility.

$512.20Office (non-facility)
$262.59Hospital or facility
−6.6%vs the national office rate ($548.44)

Check a contract rate as a % of Medicare · 28496 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 28496 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Carolina
  2. What 28496 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 28496 covers

An orthopedic surgeon or podiatric surgeon uses manipulation to reduce a great toe fracture and places skeletal fixation through the skin, typically with pins, to stabilize the fracture. This approach is used when the fracture needs fixation but is treated percutaneously rather than through open exposure. The service is generally performed in a surgical facility; Medicare’s 2024 claims data show facility services for this code.

Choose this code when the documented treatment includes both manipulation and percutaneous skeletal fixation of a great toe fracture. The operative report should identify the great toe fracture, reduction, and percutaneous fixation performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For same-session procedures, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; 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 North Carolina compares for 28496

Across 109 of 109 payment localities, the office rate for 28496 runs from $476.76 in Arkansas to $748.89 in San Benito County, CA. North Carolina pays $512.20. The RVUs are the same everywhere; the geographic indexes change the dollars.

28496 in North Carolina vs other payment areas
  1. North Carolina · this page$512.20
  2. Los Angeles, CA · California$628.66+$116.46
  3. Washington, DC area · District of Columbia$634.96+$122.76
  4. Miami, FL · Florida$592.47+$80.27
  5. Chicago, IL · Illinois$572.89+$60.69
  6. Manhattan, NY · New York$636.45+$124.25
  7. Alaska · Alaska$610.67+$98.47

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

Every other payment area

28496 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$484.83$250.73
ArkansasArkansas$476.76$246.95
ArizonaArizona$532.06$272.81
Bakersfield, CACalifornia$586.74$293.51
Chico, CACalifornia$585.36$292.13
El Centro, CACalifornia$585.44$292.21
Fresno, CACalifornia$585.36$292.13
Hanford, CACalifornia$585.36$292.13

28496 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.

$476.76

$667.13

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

View every state and territory as a table
28496 office rate range by state
State / territoryOffice rate rangeLocalities
AK$610.671
AL$484.831
AR$476.761
AZ$532.061
CA$585.36–$748.8929
CO$574.611
CT$588.291
DC$634.961
DE$541.751
FL$537.00–$592.473
GA$502.95–$559.262
GU$603.191
HI$603.191
IA$500.041
ID$503.571
IL$518.62–$574.084
IN$506.941
KS$496.871
KY$496.971
LA$495.89–$524.112
MA$570.24–$637.402
MD$553.29–$634.963
ME$506.06–$538.222
MI$511.37–$544.122
MN$549.761
MO$485.78–$526.833
MS$481.411
MT$548.411
NC$512.201
ND$538.521
NE$503.331
NH$564.841
NJ$594.78–$626.822
NM$514.371
NV$546.101
NY$520.94–$653.155
OH$509.351
OK$496.471
OR$541.68–$595.512
PA$510.55–$571.612
PR$553.151
RI$563.061
SC$511.671
SD$537.351
TN$499.681
TX$506.67–$572.858
UT$519.681
VA$535.87–$634.962
VI$553.151
VT$535.681
WA$569.40–$651.792
WI$517.951
WV$496.571
WY$544.101

See 28496 in every payment locality

How the 28496 rate is calculated

Each of 28496’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 · 28496

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.42

2.42 RVUs× 1.000 GPCI

Practice expense13.50

13.50 RVUs× 1.000 GPCI

Malpractice0.50

0.50 RVUs× 1.000 GPCI

Adjusted RVUs

16.4200

Conversion factor

$33.4009

Medicare rate

$548.44

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

The exact North Carolina inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

3,218

Code
28496
Physician work
2.42
Practice expense
13.50
Malpractice
0.50

GPCI2026.csv

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for 28496 in North Carolina
ComponentRVULocality factorAdjusted
Physician work2.42× 1.0002.4200
Practice expense13.50× 0.93312.5955
Malpractice0.50× 0.6390.3195
Total RVUs15.3350
Conversion factor× 33.4009

Office rate, North Carolina$512.20

Office: (2.42 × 1 + 13.5 × 0.933 + 0.5 × 0.639) × $33.4009 = $512.20

Facility: (2.42 × 1 + 5.49 × 0.933 + 0.5 × 0.639) × $33.4009 = $262.59

Open 28496 in the RVU calculator

Payment rules and modifiers for 28496

28496 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 28496

Great toe fracture, percutaneous fixation 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 · 28496

Great toe fracture, percutaneous fixation 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

28496 without 50 · national office

$548.44

Great toe fracture, percutaneous fixation with manipulation

28496-50 · Bilateral: 150%

$822.66

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 28496

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

Codes related to 28496
CodeHow it relatesOffice range, North Carolina
Same family
28490Toe fracture care, without manipulationGreat toe fracture treatment without manipulation or percutaneous fixation.$148.91
28495Toe fracture treatment, great toe, with manipulationGreat toe fracture treatment with manipulation but without percutaneous skeletal fixation.$184.32
Used instead
28505Toe fracture surgery, great toe, open treatmentOpen treatment for a great toe phalangeal fracture when open exposure is used.$630.47

How 28496 has changed in North Carolina

28496 · Office / nonfacility

$512.20

Effective 2026-10-01

The base rate is $55.59 higher than on 2025-10-01, moving from $456.61 to $512.20 (12.2%).

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

    $456.61changed to$512.20

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.48 changed to 2.42
    • Practice expense RVU 12.20 changed to 13.50
    • Malpractice RVU 0.51 changed to 0.50
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.665 changed to 0.639

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $472.45changed to$456.61

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 12.29 changed to 12.20
    • Malpractice RVU 0.50 changed to 0.51

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $464.74changed to$472.45

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $432.42changed to$464.74

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 10.77 changed to 12.29
    • Malpractice RVU 0.40 changed to 0.50
    • Practice expense GPCI 0.927 changed to 0.926
    • Malpractice GPCI 0.742 changed to 0.665

  5. January 1, 2023

    RVU23A

    $435.01changed to$432.42

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 10.52 changed to 10.77
    • Practice expense GPCI 0.928 changed to 0.927
    • Malpractice GPCI 0.819 changed to 0.742

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $447.11changed to$435.01

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 10.80 changed to 10.52
    • Malpractice RVU 0.38 changed to 0.40

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $439.48changed to$447.11

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 10.11 changed to 10.80
    • Malpractice RVU 0.39 changed to 0.38
    • Practice expense GPCI 0.930 changed to 0.928
    • Malpractice GPCI 0.757 changed to 0.819

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $447.58changed to$439.48

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 10.37 changed to 10.11
    • Malpractice RVU 0.41 changed to 0.39
    • Practice expense GPCI 0.931 changed to 0.930
    • Malpractice GPCI 0.695 changed to 0.757

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $446.84changed to$447.58

    • Conversion factor 35.9996 changed to 36.0391
    • Malpractice RVU 0.40 changed to 0.41

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $433.78changed to$446.84

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 10.02 changed to 10.37
    • Malpractice RVU 0.38 changed to 0.40
    • Malpractice GPCI 0.732 changed to 0.695

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $425.01changed to$433.78

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 9.80 changed to 10.02
    • Malpractice RVU 0.36 changed to 0.38
    • Practice expense GPCI 0.930 changed to 0.931
    • Malpractice GPCI 0.768 changed to 0.732

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $430.30changed to$425.01

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 9.78 changed to 9.80
    • Malpractice RVU 0.52 changed to 0.36

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $428.15changed to$430.30

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $418.31changed to$428.15

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 9.64 changed to 9.78
    • Malpractice RVU 0.33 changed to 0.52
    • Practice expense GPCI 0.929 changed to 0.930
    • Malpractice GPCI 0.732 changed to 0.768

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $440.85changed to$418.31

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 11.04 changed to 9.64
    • Malpractice RVU 0.35 changed to 0.33
    • Practice expense GPCI 0.927 changed to 0.929
    • Malpractice GPCI 0.695 changed to 0.732

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $440.85

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$512.20$262.59RVU26D
2026-07-01$512.20$262.59RVU26C
2026-04-01$512.20$262.59RVU26B
2026-01-01$512.20$262.59RVU26A
2025-10-01$456.61$257.43RVU25D
2025-07-01$456.61$257.43RVU25C
2025-04-01$456.61$257.43RVU25B
2025-01-01$456.61$257.43RVU25A
2024-10-01$472.45$261.61RVU24D
2024-07-01$472.45$261.61RVU24C
2024-04-01$472.45$261.61RVU24B
2024-03-09$472.45$261.61RVU24AR
2024-01-01$464.74$257.34RVU24A
2023-10-01$432.42$238.91RVU23D
2023-07-01$432.42$238.91RVU23C
2023-04-01$432.42$238.91RVU23B
2023-01-01$432.42$238.91RVU23A
2022-10-01$435.01$237.50RVU22D
2022-07-01$435.01$237.50RVU22C
2022-04-01$435.01$237.50RVU22B
2022-01-01$435.01$237.50RVU22A
2021-10-01$447.11$237.28RVU21D
2021-07-01$447.11$237.28RVU21C
2021-04-01$447.11$237.28RVU21B
2021-01-01$447.11$237.28RVU21A
2020-10-01$439.48$236.42RVU20D
2020-07-01$439.48$236.42RVU20C
2020-04-01$439.48$236.42RVU20B
2020-01-01$439.48$236.42RVU20A
2019-10-01$447.58$238.55RVU19D
2019-07-01$447.58$238.55RVU19C
2019-04-01$447.58$238.55RVU19B
2019-01-01$447.58$238.55RVU19A
2018-10-01$446.84$237.37RVU18D
2018-07-01$446.84$237.37RVU18C
2018-04-01$446.84$237.37RVU18B
2018-01-01$446.84$237.37RVU18AR1
2017-10-01$433.78$231.97RVU17D
2017-07-01$433.78$231.97RVU17C
2017-04-01$433.78$231.97RVU17B
2017-01-01$433.78$231.97RVU17A
2016-10-01$425.01$227.89RVU16D
2016-07-01$425.01$227.89RVU16C
2016-04-01$425.01$227.89RVU16B
2016-01-01$425.01$227.89RVU16A
2015-10-01$430.30$232.13RVU15D
2015-07-01$430.30$232.13RVU15C
2015-04-01$428.15$230.97RVU15B
2015-01-01$428.15$230.97RVU15A
2014-10-01$418.31$224.95RVU14D
2014-07-01$418.31$224.95RVU14C
2014-04-01$418.31$224.95RVU14B
2014-01-01$418.31$224.95RVU14A
2013-10-01$440.85$230.16RVU13D
2013-07-01$440.85$230.16RVU13C
2013-04-01$440.85$230.16RVU13B
2013-01-01$440.85$230.16RVU13AR

Price 28496 for an earlier date of service

Where the North Carolina rate applies

North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Advance
  • Ahoskie
  • Alamance
  • Albemarle
  • Alexis
  • Alliance
  • Altamahaw

Browse all communities in North Carolina

28496 billing questions

How does this differ from 28495?

28495 describes closed treatment with manipulation. Use 28496 when the great toe fracture is also treated with percutaneous skeletal fixation.

How does this differ from 28490?

28490 is closed treatment without manipulation. This code represents manipulation plus percutaneous skeletal fixation.

Can the fixation be reported separately from the fracture treatment?

Percutaneous skeletal fixation is part of the service represented by 28496. Do not report a separate fracture-treatment code for the same great toe fracture.

What should the operative note document?

Document the great toe fracture, manipulation or reduction, and the percutaneous skeletal fixation performed. The record should support that the treatment went beyond closed reduction alone.

How is bilateral treatment reported?

When both great toes are treated, report bilateral services with modifier 50. CMS pays bilateral reporting at 150%.

Does the code include related postoperative visits?

Yes. Its 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

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 28496PPRRVU2026_Oct_nonQPP.csv, line 3,218 (RVU26D)
Geographic factors for North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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