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CPT code 28525: Toe fracture repair, lesser toe, open treatment2026 Medicare rate & RVUs in North Carolina

Surgical exposure and treatment of a fracture in a toe other than the great toe, with internal fixation included when performed.

CMS RVU26DEffective Oct 1, 2026One payment locality330 Medicare services in 2024

In North Carolina, Medicare pays $540.56 for 28525 in the office and $365.42 when it’s performed in a hospital or facility.

$540.56Office (non-facility)
$365.42Hospital or facility
−5.7%vs the national office rate ($573.49)

Check a contract rate as a % of Medicare · 28525 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 28525 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Carolina
  2. What 28525 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 28525 covers

This service treats a fracture of a lesser-toe phalanx by surgically exposing the fracture and addressing its alignment. Internal fixation, such as pins or screws, is included when performed. “Open treatment” refers to the surgical approach; it does not mean the injury itself must be an open wound. Orthopedic surgeons and podiatrists may perform the procedure, commonly in an operating room for a displaced or unstable lesser-toe fracture requiring operative treatment.

Report this code for open treatment of a phalanx fracture in a toe other than the great toe; use the operative report to support the toe and fracture site, surgical exposure, reduction, and any fixation. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. 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% multiple-procedure reduction. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment requires documentation of medical necessity; 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 28525

Across 109 of 109 payment localities, the office rate for 28525 runs from $510.51 in Arkansas to $745.33 in San Benito County, CA. North Carolina pays $540.56. The RVUs are the same everywhere; the geographic indexes change the dollars.

28525 in North Carolina vs other payment areas
  1. North Carolina · this page$540.56
  2. Los Angeles, CA · California$640.49+$99.93
  3. Washington, DC area · District of Columbia$651.38+$110.82
  4. Miami, FL · Florida$623.80+$83.24
  5. Chicago, IL · Illinois$606.46+$65.90
  6. Manhattan, NY · New York$658.23+$117.67
  7. Alaska · Alaska$678.55+$137.99

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

Every other payment area

28525 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$517.56$353.32
ArkansasArkansas$510.51$349.27
ArizonaArizona$558.79$376.89
Bakersfield, CACalifornia$603.23$397.50
Chico, CACalifornia$601.18$395.45
El Centro, CACalifornia$601.30$395.56
Fresno, CACalifornia$601.18$395.45
Hanford, CACalifornia$601.18$395.45

28525 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.

$510.51

$678.55

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

View every state and territory as a table
28525 office rate range by state
State / territoryOffice rate rangeLocalities
AK$678.551
AL$517.561
AR$510.511
AZ$558.791
CA$601.18–$745.3329
CO$594.161
CT$610.281
DC$651.381
DE$567.671
FL$568.92–$623.803
GA$538.24–$584.552
GU$614.131
HI$614.131
IA$528.371
ID$531.961
IL$554.50–$606.464
IN$534.831
KS$526.791
KY$530.751
LA$530.27–$554.952
MA$591.22–$649.742
MD$577.84–$651.383
ME$535.39–$561.682
MI$544.50–$576.442
MN$567.921
MO$522.19–$555.903
MS$516.411
MT$573.451
NC$540.561
ND$559.801
NE$530.871
NH$585.681
NJ$616.85–$645.382
NM$547.631
NV$570.011
NY$548.28–$674.405
OH$541.711
OK$529.041
OR$565.18–$611.302
PA$542.10–$596.302
PR$577.191
RI$586.611
SC$542.111
SD$558.191
TN$529.391
TX$538.79–$592.548
UT$549.101
VA$560.47–$651.382
VI$577.191
VT$558.431
WA$589.84–$661.832
WI$542.111
WV$535.301
WY$567.501

See 28525 in every payment locality

How the 28525 rate is calculated

Each of 28525’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 · 28525

RVUs × geographic indexes × conversion factor

Office or facility?

Work5.48

5.48 RVUs× 1.000 GPCI

Practice expense11.00

11.00 RVUs× 1.000 GPCI

Malpractice0.69

0.69 RVUs× 1.000 GPCI

Adjusted RVUs

17.1700

Conversion factor

$33.4009

Medicare rate

$573.49

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

3,222

Code
28525
Physician work
5.48
Practice expense
11.00
Malpractice
0.69

GPCI2026.csv

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for 28525 in North Carolina
ComponentRVULocality factorAdjusted
Physician work5.48× 1.0005.4800
Practice expense11.00× 0.93310.2630
Malpractice0.69× 0.6390.4409
Total RVUs16.1839
Conversion factor× 33.4009

Office rate, North Carolina$540.56

Office: (5.48 × 1 + 11 × 0.933 + 0.69 × 0.639) × $33.4009 = $540.56

Facility: (5.48 × 1 + 5.38 × 0.933 + 0.69 × 0.639) × $33.4009 = $365.42

Open 28525 in the RVU calculator

Payment rules and modifiers for 28525

28525 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 28525

Toe fracture repair, lesser toe, open treatment

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)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
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 · 28525

Toe fracture repair, lesser toe, open treatment

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 51 · payment effect

With and without the modifier

28525 without 51 · national office

$573.49

Toe fracture repair, lesser toe, open treatment

28525-51 · Second procedure: 50%

$286.75

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

Codes related to 28525

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

Codes related to 28525
CodeHow it relatesOffice range, North Carolina
Same family
28505Toe fracture surgery, great toe, open treatmentOpen treatment of a great-toe fracture; this code covers other toes.$630.47
28510Toe fracture care, without manipulationClosed treatment of a lesser-toe fracture without manipulation.$123.24
28515Toe fracture care, with manipulationClosed treatment of a lesser-toe fracture with manipulation.$164.31

How 28525 has changed in North Carolina

28525 · Office / nonfacility

$540.56

Effective 2026-10-01

The base rate is $27.97 higher than on 2025-10-01, moving from $512.59 to $540.56 (5.5%).

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

    $512.59changed to$540.56

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 5.62 changed to 5.48
    • Practice expense RVU 10.57 changed to 11.00
    • Malpractice RVU 0.66 changed to 0.69
    • 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

    $537.10changed to$512.59

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 10.86 changed to 10.57
    • Malpractice RVU 0.69 changed to 0.66

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $528.33changed to$537.10

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $542.16changed to$528.33

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 10.66 changed to 10.86
    • Malpractice RVU 0.67 changed to 0.69
    • Practice expense GPCI 0.927 changed to 0.926
    • Malpractice GPCI 0.742 changed to 0.665

  5. January 1, 2023

    RVU23A

    $552.81changed to$542.16

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 10.54 changed to 10.66
    • Malpractice RVU 0.70 changed to 0.67
    • 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

    $561.68changed to$552.81

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 10.69 changed to 10.54
    • Malpractice RVU 0.68 changed to 0.70

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $563.87changed to$561.68

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 10.22 changed to 10.69
    • Malpractice RVU 0.66 changed to 0.68
    • 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

    $560.47changed to$563.87

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 10.19 changed to 10.22
    • Malpractice RVU 0.64 changed to 0.66
    • 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

    $559.52changed to$560.47

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 10.18 changed to 10.19

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $553.04changed to$559.52

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 10.02 changed to 10.18
    • Malpractice RVU 0.63 changed to 0.64
    • Malpractice GPCI 0.732 changed to 0.695

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $554.46changed to$553.04

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 10.08 changed to 10.02
    • Malpractice RVU 0.64 changed to 0.63
    • 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

    $549.50changed to$554.46

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 9.88 changed to 10.08
    • Malpractice RVU 0.63 changed to 0.64

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $546.77changed to$549.50

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $552.95changed to$546.77

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 10.03 changed to 9.88
    • Malpractice RVU 0.68 changed to 0.63
    • 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

    $554.62changed to$552.95

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 10.99 changed to 10.03
    • Malpractice RVU 0.71 changed to 0.68
    • 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: $554.62

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$540.56$365.42RVU26D
2026-07-01$540.56$365.42RVU26C
2026-04-01$540.56$365.42RVU26B
2026-01-01$540.56$365.42RVU26A
2025-10-01$512.59$376.90RVU25D
2025-07-01$512.59$376.90RVU25C
2025-04-01$512.59$376.90RVU25B
2025-01-01$512.59$376.90RVU25A
2024-10-01$537.10$389.76RVU24D
2024-07-01$537.10$389.76RVU24C
2024-04-01$537.10$389.76RVU24B
2024-03-09$537.10$389.76RVU24AR
2024-01-01$528.33$383.40RVU24A
2023-10-01$542.16$391.06RVU23D
2023-07-01$542.16$391.06RVU23C
2023-04-01$542.16$391.06RVU23B
2023-01-01$542.16$391.06RVU23A
2022-10-01$552.81$395.45RVU22D
2022-07-01$552.81$395.45RVU22C
2022-04-01$552.81$395.45RVU22B
2022-01-01$552.81$395.45RVU22A
2021-10-01$561.68$394.60RVU21D
2021-07-01$561.68$394.60RVU21C
2021-04-01$561.68$394.60RVU21B
2021-01-01$561.68$394.60RVU21A
2020-10-01$563.87$399.75RVU20D
2020-07-01$563.87$399.75RVU20C
2020-04-01$563.87$399.75RVU20B
2020-01-01$563.87$399.75RVU20A
2019-10-01$560.47$395.73RVU19D
2019-07-01$560.47$395.73RVU19C
2019-04-01$560.47$395.73RVU19B
2019-01-01$560.47$395.73RVU19A
2018-10-01$559.52$393.62RVU18D
2018-07-01$559.52$393.62RVU18C
2018-04-01$559.52$393.62RVU18B
2018-01-01$559.52$393.62RVU18AR1
2017-10-01$553.04$390.65RVU17D
2017-07-01$553.04$390.65RVU17C
2017-04-01$553.04$390.65RVU17B
2017-01-01$553.04$390.65RVU17A
2016-10-01$554.46$392.30RVU16D
2016-07-01$554.46$392.30RVU16C
2016-04-01$554.46$392.30RVU16B
2016-01-01$554.46$392.30RVU16A
2015-10-01$549.50$388.43RVU15D
2015-07-01$549.50$388.43RVU15C
2015-04-01$546.77$386.50RVU15B
2015-01-01$546.77$386.50RVU15A
2014-10-01$552.95$391.88RVU14D
2014-07-01$552.95$391.88RVU14C
2014-04-01$552.95$391.88RVU14B
2014-01-01$552.95$391.88RVU14A
2013-10-01$554.62$386.20RVU13D
2013-07-01$554.62$386.20RVU13C
2013-04-01$554.62$386.20RVU13B
2013-01-01$554.62$386.20RVU13AR

Price 28525 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

28525 billing questions

How is this different from code 28505?

Code 28525 is for open treatment of a fracture in a toe other than the great toe. Code 28505 is the corresponding open-treatment code for a great-toe fracture.

Is internal fixation separately reported?

Internal fixation is included in this service when performed. The operative report should describe the reduction and any pins, screws, or other fixation used.

How does this differ from codes 28510 and 28515?

Those codes describe closed treatment of a lesser-toe fracture, without manipulation for 28510 and with manipulation for 28515. Code 28525 describes open surgical treatment.

Can modifier 50 be used for fractures in both feet?

CMS identifies bilateral adjustment as inappropriate for this code based on its descriptor or anatomy. Modifier 50 should not be applied.

What postoperative care is included?

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

When is assistant-at-surgery payment allowed?

Payment for an assistant at surgery requires documentation of medical necessity. 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 28525PPRRVU2026_Oct_nonQPP.csv, line 3,222 (RVU26D)
Geographic factors for North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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