Billing code 28315: SesamoidectomyMedicare rate & RVUs

Medicare pays $481.31 for 28315 nationally in the office and $310.96 in a hospital or facility. Local office rates run $430.22–$623.59.

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

What 28315 covers

This procedure removes a sesamoid bone in the foot, most often one of the small bones beneath the first metatarsal head at the great toe. Podiatrists and orthopedic surgeons may perform it for persistent focal pain associated with sesamoiditis, fracture, nonunion, or avascular change when surgery is chosen. The work may take place in an operating room or an appropriately equipped outpatient surgical setting.

Report the procedure for removal of the sesamoid itself, not an osteotomy of a metatarsal or correction of a toe deformity alone. The operative report should identify the treated foot and sesamoid, the indication, and the removal performed. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 bilateral procedures are paid at 150%. Assistant-at-surgery payment is restricted; co-surgeon payment requires 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 28315 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

28315 rates by state

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

How the 28315 rate is calculated

Each of 28315’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 28315

28315 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

28315 compared with similar codes

How to choose

28308Metatarsal osteotomy

This code concerns a metatarsal osteotomy. Choose sesamoid removal when the operative target is the sesamoid bone rather than a metatarsal cut or realignment.

28124Toe bone excision

This code describes partial excision of a toe phalanx. It is not the code for removal of a sesamoid beneath the great toe.

28296Bunion correction

This code describes hallux valgus correction with a distal metatarsal osteotomy. Sesamoid removal alone does not represent that deformity-correction procedure.

Codes related to 28315

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