Billing code 28086: Tendon sheath excisionMedicare rate & RVUs
Surgical excision of diseased foot tendon sheath tissue, commonly for a sheath-associated ganglion, when the surgeon removes one tendon sheath.
Medicare pays $540.43 for 28086 nationally in the office and $335.68 in a hospital or facility. Local office rates run $479.36–$706.40.
Medicare rate · 28086
Tendon sheath excision
Swap in your local Medicare rate.
- Work RVUs
- 4.8
- Total RVUs
- 16.18
- Global days
- 090
National rate · 2026
$540.43
Office setting, before claim adjustments.
See every locality for 28086 → · Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 10 sections
What 28086 covers
This procedure removes abnormal tissue from a tendon sheath in the foot, often when a ganglion arises from or involves the sheath. An orthopedic surgeon or podiatric surgeon typically performs the excision in an operating room or ambulatory surgery setting. The operative report should identify the tendon and foot location, describe the sheath tissue removed, and clarify whether the target was a sheath-associated lesion rather than a joint, nerve, or separate soft-tissue mass.
Report 28086 for the primary tendon sheath excision; 28088 is the add-on code for an additional sheath. The service has a 90-day 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 the others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be made; co-surgeons require supporting documentation, and team surgery is 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 28086 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$479.36 to $706.40
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $486.21 | $307.05 |
| Alaska* | $634.14 | $416.08 |
| Arizona | $526.19 | $327.79 |
| Arkansas | $479.36 | $303.49 |
| Atlanta | $551.01 | $342.98 |
| Austin | $559.06 | $342.44 |
| Bakersfield | $569.39 | $344.99 |
| Baltimore/Surr. Cntys | $574.30 | $354.61 |
| Beaumont | $506.63 | $320.31 |
| Brazoria | $533.71 | $330.80 |
| Chicago | $571.46 | $365.68 |
| Chico | $567.48 | $343.08 |
| Colorado | $560.53 | $342.68 |
| Connecticut | $575.79 | $355.28 |
| Dallas | $537.35 | $333.42 |
| Dc + Md/Va Suburbs | $615.33 | $374.14 |
| Delaware | $534.73 | $332.44 |
| Detroit | $542.78 | $345.19 |
| East St. Louis | $533.77 | $345.40 |
| El Centro | $567.59 | $343.19 |
| Fort Lauderdale | $562.63 | $355.22 |
| Fort Worth | $534.05 | $332.17 |
| Fresno | $567.48 | $343.08 |
| Galveston | $535.47 | $332.15 |
| Hanford-Corcoran | $567.48 | $343.08 |
| Hawaii, Guam | $580.39 | $347.59 |
| Houston | $547.36 | $344.05 |
| Idaho | $500.31 | $311.95 |
| Indiana | $503.10 | $313.30 |
| Iowa | $496.87 | $309.53 |
| Kansas | $495.25 | $310.16 |
| Kentucky | $498.80 | $316.78 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $605.29 | $363.07 |
| Madera | $567.48 | $343.08 |
| Manhattan | $621.47 | $383.55 |
| Merced | $567.48 | $343.08 |
| Metropolitan Boston | $614.14 | $369.67 |
| Metropolitan Kansas City | $518.07 | $325.81 |
| Metropolitan Philadelphia | $562.20 | $349.05 |
| Metropolitan St. Louis | $523.27 | $328.35 |
| Miami | $588.32 | $375.17 |
| Minnesota | $535.54 | $324.85 |
| Mississippi | $484.94 | $308.66 |
| Modesto | $567.48 | $343.08 |
| Montana** | $540.38 | $335.64 |
| Napa | $653.81 | $383.96 |
| Nebraska | $499.33 | $310.34 |
| Nevada** | $537.16 | $332.21 |
| New Hampshire | $552.41 | $339.26 |
| New Mexico | $515.04 | $327.29 |
| New Orleans | $522.23 | $329.57 |
| North Carolina | $508.58 | $317.55 |
| North Dakota** | $527.53 | $322.78 |
| Northern Nj | $609.35 | $371.84 |
| Nyc Suburbs/Long Island | $637.03 | $393.58 |
| Ohio | $509.42 | $322.49 |
| Oklahoma | $497.24 | $314.40 |
| Oxnard-Thousand Oaks-Ventura | $601.96 | $359.95 |
| Portland | $577.22 | $349.74 |
| Poughkpsie/N Nyc Suburbs | $586.25 | $362.05 |
| Puerto Rico | $544.04 | $337.04 |
| Queens | $625.51 | $383.50 |
| Redding | $567.48 | $343.08 |
| Rest Of California | $567.48 | $343.08 |
| Rest Of Florida | $535.58 | $339.84 |
| Rest Of Georgia | $505.89 | $323.25 |
| Rest Of Illinois | $521.47 | $334.54 |
| Rest Of Louisiana | $498.30 | $317.10 |
| Rest Of Maine | $503.55 | $315.18 |
| Rest Of Maryland | $544.55 | $337.35 |
| Rest Of Massachusetts | $557.58 | $341.98 |
| Rest Of Michigan | $512.05 | $325.11 |
| Rest Of Missouri | $490.40 | $313.91 |
| Rest Of New Jersey | $581.92 | $358.33 |
| Rest Of New York | $516.06 | $321.55 |
| Rest Of Oregon | $532.54 | $328.62 |
| Rest Of Pennsylvania | $509.84 | $321.89 |
| Rest Of Texas | $520.04 | $325.74 |
| Rest Of Washington | $556.32 | $340.72 |
| Rhode Island | $552.95 | $341.45 |
| Riverside-San Bernardino-Ontario | $574.53 | $350.12 |
| Sacramento-Roseville-Folsom | $594.54 | $356.42 |
| Salinas | $592.31 | $355.00 |
| San Diego-Chula Vista-Carlsbad | $605.54 | $360.66 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $690.85 | $402.16 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $690.11 | $401.42 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $706.40 | $411.15 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $703.38 | $408.13 |
| San Luis Obispo-Paso Robles | $582.89 | $349.69 |
| Santa Cruz-Watsonville | $610.77 | $362.01 |
| Santa Maria-Santa Barbara | $594.33 | $355.60 |
| Santa Rosa-Petaluma | $616.88 | $365.45 |
| Seattle (King Cnty) | $625.82 | $374.60 |
| South Carolina | $509.93 | $320.75 |
| South Dakota** | $526.01 | $321.26 |
| Southern Maine | $529.19 | $326.29 |
| Stockton | $567.48 | $343.08 |
| Suburban Chicago | $567.99 | $357.71 |
| Tennessee | $497.76 | $311.65 |
| Utah | $516.71 | $324.25 |
| Vallejo | $652.75 | $382.89 |
| Vermont | $526.12 | $323.42 |
| Virgin Islands | $544.04 | $337.04 |
| Virginia | $527.95 | $326.68 |
| Visalia | $567.48 | $343.08 |
| West Virginia | $502.83 | $324.91 |
| Wisconsin | $510.35 | $314.20 |
| Wyoming** | $534.78 | $330.03 |
| Yuba City | $567.48 | $343.08 |
28086 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$479.36
$636.94
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $634.14 | 1 |
| AL | $486.21 | 1 |
| AR | $479.36 | 1 |
| AZ | $526.19 | 1 |
| CA | $567.48–$706.40 | 29 |
| CO | $560.53 | 1 |
| CT | $575.79 | 1 |
| DC | $615.33 | 1 |
| DE | $534.73 | 1 |
| FL | $535.58–$588.32 | 3 |
| GA | $505.89–$551.01 | 2 |
| GU | $580.39 | 1 |
| HI | $580.39 | 1 |
| IA | $496.87 | 1 |
| ID | $500.31 | 1 |
| IL | $521.47–$571.46 | 4 |
| IN | $503.10 | 1 |
| KS | $495.25 | 1 |
| KY | $498.80 | 1 |
| LA | $498.30–$522.23 | 2 |
| MA | $557.58–$614.14 | 2 |
| MD | $544.55–$615.33 | 3 |
| ME | $503.55–$529.19 | 2 |
| MI | $512.05–$542.78 | 2 |
| MN | $535.54 | 1 |
| MO | $490.40–$523.27 | 3 |
| MS | $484.94 | 1 |
| MT | $540.38 | 1 |
| NC | $508.58 | 1 |
| ND | $527.53 | 1 |
| NE | $499.33 | 1 |
| NH | $552.41 | 1 |
| NJ | $581.92–$609.35 | 2 |
| NM | $515.04 | 1 |
| NV | $537.16 | 1 |
| NY | $516.06–$637.03 | 5 |
| OH | $509.42 | 1 |
| OK | $497.24 | 1 |
| OR | $532.54–$577.22 | 2 |
| PA | $509.84–$562.20 | 2 |
| PR | $544.04 | 1 |
| RI | $552.95 | 1 |
| SC | $509.93 | 1 |
| SD | $526.01 | 1 |
| TN | $497.76 | 1 |
| TX | $506.63–$559.06 | 8 |
| UT | $516.71 | 1 |
| VA | $527.95–$615.33 | 2 |
| VI | $544.04 | 1 |
| VT | $526.12 | 1 |
| WA | $556.32–$625.82 | 2 |
| WI | $510.35 | 1 |
| WV | $502.83 | 1 |
| WY | $534.78 | 1 |
How the 28086 rate is calculated
Each of 28086’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 · 28086
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.80Practice expense 10.73Malpractice 0.65
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 28086
28086 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 28086
Tendon sheath excision
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 28086
Tendon sheath excision
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
28086 without 50 · national office
$540.43
Tendon sheath excision
28086-50 · Bilateral: 150%
$810.64
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).
28086 compared with similar codes
Compare codes
28086 vs 28088 vs 28010 vs 28039: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 28088Tendon sheath surgery
- 28086 covers the primary tendon sheath excision; 28088 is reported for each additional sheath excised.
- 28010Toe tendon release
- 28010 is for incision of a toe tendon. Choose 28086 when the surgeon excises tendon sheath tissue rather than releasing the tendon.
- 28039Tumor excision
- 28039 addresses a qualifying subcutaneous foot or toe tumor. Use 28086 when the excised target is tendon sheath tissue or a sheath-associated ganglion.
28086 billing questions
When is 28086 used instead of 28088?
Use 28086 for the primary tendon sheath excision. Use 28088 for each additional sheath excised in the same operative session.
Is a tendon sheath ganglion included in this procedure?
Yes, a ganglion arising from or involving a foot tendon sheath is a typical reason for excision. The operative note should establish the sheath relationship and tissue removed.
How does 28086 differ from tendon incision codes 28010 and 28011?
28086 reports excision of tendon sheath tissue. Codes 28010 and 28011 describe tendon incision or release, not removal of the sheath.
What documentation supports reporting 28086?
Document the foot and tendon location, the sheath or sheath-associated lesion excised, and the extent of removal. If another sheath is excised, identify it to support the additional-sheath code.
What global and multiple-procedure payment rules apply?
The code has a 90-day global period. When procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%.
Can modifier 50 or an assistant-at-surgery service be reported?
Bilateral reporting with modifier 50 is paid at 150%, and assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation.
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
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