Billing code 28525: Toe fracture repairMedicare rate & RVUs

Medicare pays $573.49 for 28525 nationally in the office and $385.78 in a hospital or facility. Local office rates run $510.51–$745.33.

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

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.

Where 28525 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

28525 rates by state

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

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.

Payment rules and modifiers for 28525

28525 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 51

28525 compared with similar codes

How to choose

28505Toe fracture surgery

Use 28505 for open treatment of a great-toe phalanx fracture. Use 28525 for a phalanx fracture in another toe.

28510Toe fracture care

Code 28510 describes closed treatment of a lesser-toe fracture without manipulation; 28525 describes open surgical treatment.

28515Toe fracture care

Code 28515 describes closed treatment of a lesser-toe fracture with manipulation. Surgical exposure and treatment point to 28525 instead.

Codes related to 28525

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