Billing code 28043: Tumor excisionMedicare rate & RVUs

Medicare pays $382.11 for 28043 nationally in the office and $247.50 in a hospital or facility. Local office rates run $341.81–$496.09.

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

What 28043 covers

This code describes removing a soft-tissue tumor located in the subcutaneous layer of the foot or toe, with a size under 1.5 cm. The lesion lies beneath the skin but does not extend into deeper tissue such as fascia or muscle. Podiatric and orthopedic surgeons commonly perform this procedure for a localized mass in an office or surgical facility; the excised tissue may be sent for pathologic examination.

Select the code based on both the lesion’s size and its depth, not simply the incision length. The operative report should identify the foot or toe site, document the tumor’s size, and show that it was subcutaneous. This major surgery code has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. 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.

Where 28043 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

28043 rates by state

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

How the 28043 rate is calculated

Each of 28043’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 28043

28043 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

28043 compared with similar codes

How to choose

28039Tumor excision

Both apply to subcutaneous foot or toe tumors; choose 28039 when the lesion measures 1.5 cm or greater.

28045Foot mass excision

Both apply to tumors under 1.5 cm, but 28045 is for a deep, rather than subcutaneous, location.

28041Tumor excision

This code is for a subcutaneous tumor under 1.5 cm. Code 28041 describes a deep tumor measuring 1.5 cm or greater.

Codes related to 28043

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