$287.14–$432.04
Both codes address closed treatment of a sesamoid fracture. Use 28530 when the fragments are not manipulated and 28531 when the provider manipulates them.
On this page
CMS RVU26D · Effective 2026-10-01
28530 Sesamoid fracture care Medicare reimbursement rates
Report this service for closed treatment of a fractured foot sesamoid when the fracture is managed without manipulating the bone fragments. Compare 28530 office and facility rates across CMS payment localities.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 28530?
The service location and office or facility setting determine which base rate applies. These are the supported base rates for the 109 payment areas shown below, using the same CMS release.
Office / nonfacility
$109.87–$162.60
109 of 109 localities have a supported rate.
Lowest: Arkansas
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $52.73 per service.
Facility setting
$92.36–$133.22
109 of 109 localities have a supported rate.
Lowest: Arkansas
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $40.86 per service.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 28530 pays more and less
109 payment localities
$109.87 to $162.60
Foot fracture care
About 28530: Closed sesamoid fracture treatment without manipulation
Report this service for closed treatment of a fractured foot sesamoid when the fracture is managed without manipulating the bone fragments.
This code describes closed management of a fractured sesamoid without manipulating the bone fragments. Sesamoids are small bones beneath the first metatarsal head; a patient may present with pain and tenderness under the ball of the foot after an injury. Orthopedic surgeons, podiatrists, and other qualified clinicians may provide the fracture care in an office, clinic, or facility setting. The service is distinct from treatment of a toe phalanx fracture, even when symptoms are near the great toe.
Select this code when the provider documents a sesamoid fracture and closed treatment without manipulation. The record should identify the fracture site and show the treatment plan; use the manipulation code when the fragments are manipulated instead. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in one session, the highest-valued is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 28530
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.08 · 29%
- Practice expense (office) RVU2.50 · 68%
- Malpractice RVU0.12 · 3%
109
Medicare services in 2024 · #4813 by national volume
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.
28530 compared with similar codes
Office rate ranges across all CMS payment localities, from the same CMS release.
$116.12–$171.62
28510 is for a lesser-toe phalanx fracture treated closed without manipulation. 28530 is for the sesamoid, not a toe phalanx.
$139.70–$210.99
28490 concerns a great-toe phalanx fracture treated closed without manipulation. Choose 28530 when the injured bone is a sesamoid.
$597.34–$854.62
28505 describes open treatment of a great-toe fracture. 28530 is closed treatment of a sesamoid fracture without manipulation.
See how rates vary across the country
28530 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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.
$109.87
$146.48
Color shows the midpoint of each state’s locality range.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | $145.25 | 1 |
| AL | $111.41 | 1 |
| AR | $109.87 | 1 |
| AZ | $120.42 | 1 |
| CA | $130.35–$162.60 | 29 |
| CO | $128.48 | 1 |
| CT | $131.58 | 1 |
| DC | $140.85 | 1 |
| DE | $122.36 | 1 |
| FL | $121.93–$133.14 | 3 |
| GA | $115.33–$125.83 | 2 |
| GU | $133.34 | 1 |
| HI | $133.34 | 1 |
| IA | $114.07 | 1 |
| ID | $114.79 | 1 |
| IL | $118.58–$129.44 | 4 |
| IN | $115.43 | 1 |
| KS | $113.58 | 1 |
| KY | $113.97 | 1 |
| LA | $113.81–$119.20 | 2 |
| MA | $127.77–$140.82 | 2 |
| MD | $124.62–$140.85 | 3 |
| ME | $115.39–$121.35 | 2 |
| MI | $116.84–$123.41 | 2 |
| MN | $123.18 | 1 |
| MO | $111.96–$119.58 | 3 |
| MS | $110.93 | 1 |
| MT | $123.58 | 1 |
| NC | $116.54 | 1 |
| ND | $121.20 | 1 |
| NE | $114.66 | 1 |
| NH | $126.51 | 1 |
| NJ | $133.10–$139.49 | 2 |
| NM | $117.46 | 1 |
| NV | $123.00 | 1 |
| NY | $118.22–$145.11 | 5 |
| OH | $116.35 | 1 |
| OK | $113.75 | 1 |
| OR | $122.06–$132.40 | 2 |
| PA | $116.52–$128.43 | 2 |
| PR | $124.44 | 1 |
| RI | $126.59 | 1 |
| SC | $116.64 | 1 |
| SD | $120.92 | 1 |
| TN | $114.13 | 1 |
| TX | $115.78–$128.04 | 8 |
| UT | $118.16 | 1 |
| VA | $120.99–$140.85 | 2 |
| VI | $124.44 | 1 |
| VT | $120.77 | 1 |
| WA | $127.52–$143.61 | 2 |
| WI | $117.30 | 1 |
| WV | $114.37 | 1 |
| WY | $122.54 | 1 |
Compare 28530 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | Office $111.41 | Facility $93.58 |
| Alaska* | Office $145.25 | Facility $123.55 |
| Arizona | Office $120.42 | Facility $100.67 |
| Arkansas | Office $109.87 | Facility $92.36 |
| Atlanta | Office $125.83 | Facility $105.13 |
| Austin | Office $128.04 | Facility $106.49 |
| Bakersfield | Office $130.72 | Facility $108.39 |
| Baltimore/Surr. Cntys | Office $131.21 | Facility $109.34 |
| Beaumont | Office $115.78 | Facility $97.24 |
| Brazoria | Office $122.24 | Facility $102.05 |
| Chicago | Office $129.44 | Facility $108.97 |
| Chico | Office $130.35 | Facility $108.02 |
| Colorado | Office $128.48 | Facility $106.80 |
| Connecticut | Office $131.58 | Facility $109.63 |
| Dallas | Office $123.00 | Facility $102.71 |
| Dc + Md/Va Suburbs | Office $140.85 | Facility $116.85 |
| Delaware | Office $122.36 | Facility $102.23 |
| Detroit | Office $123.41 | Facility $103.75 |
| East St. Louis | Office $120.97 | Facility $102.22 |
| El Centro | Office $130.37 | Facility $108.04 |
| Fort Lauderdale | Office $127.91 | Facility $107.27 |
| Fort Worth | Office $122.22 | Facility $102.13 |
| Fresno | Office $130.35 | Facility $108.02 |
| Galveston | Office $122.60 | Facility $102.37 |
| Hanford-Corcoran | Office $130.35 | Facility $108.02 |
| Hawaii, Guam | Office $133.34 | Facility $110.17 |
| Houston | Office $124.79 | Facility $104.56 |
| Idaho | Office $114.79 | Facility $96.05 |
| Indiana | Office $115.43 | Facility $96.54 |
| Iowa | Office $114.07 | Facility $95.43 |
| Kansas | Office $113.58 | Facility $95.16 |
| Kentucky | Office $113.97 | Facility $95.86 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office $139.00 | Facility $114.89 |
| Madera | Office $130.35 | Facility $108.02 |
| Manhattan | Office $141.77 | Facility $118.09 |
| Merced | Office $130.35 | Facility $108.02 |
| Metropolitan Boston | Office $140.82 | Facility $116.49 |
| Metropolitan Kansas City | Office $118.40 | Facility $99.27 |
| Metropolitan Philadelphia | Office $128.43 | Facility $107.22 |
| Metropolitan St. Louis | Office $119.58 | Facility $100.19 |
| Miami | Office $133.14 | Facility $111.93 |
| Minnesota | Office $123.18 | Facility $102.22 |
| Mississippi | Office $110.93 | Facility $93.39 |
| Modesto | Office $130.35 | Facility $108.02 |
| Montana** | Office $123.58 | Facility $103.20 |
| Napa | Office $150.44 | Facility $123.58 |
| Nebraska | Office $114.66 | Facility $95.85 |
| Nevada** | Office $123.00 | Facility $102.60 |
| New Hampshire | Office $126.51 | Facility $105.30 |
| New Mexico | Office $117.46 | Facility $98.77 |
| New Orleans | Office $119.20 | Facility $100.03 |
| North Carolina | Office $116.54 | Facility $97.53 |
| North Dakota** | Office $121.20 | Facility $100.83 |
| Northern Nj | Office $139.49 | Facility $115.85 |
| Nyc Suburbs/Long Island | Office $145.11 | Facility $120.88 |
| Ohio | Office $116.35 | Facility $97.75 |
| Oklahoma | Office $113.75 | Facility $95.56 |
| Oxnard-Thousand Oaks-Ventura | Office $138.28 | Facility $114.20 |
| Portland | Office $132.40 | Facility $109.77 |
| Poughkpsie/N Nyc Suburbs | Office $133.98 | Facility $111.67 |
| Puerto Rico | Office $124.44 | Facility $103.84 |
| Queens | Office $142.86 | Facility $118.78 |
| Redding | Office $130.35 | Facility $108.02 |
| Rest Of California | Office $130.35 | Facility $108.02 |
| Rest Of Florida | Office $121.93 | Facility $102.45 |
| Rest Of Georgia | Office $115.33 | Facility $97.16 |
| Rest Of Illinois | Office $118.58 | Facility $99.97 |
| Rest Of Louisiana | Office $113.81 | Facility $95.78 |
| Rest Of Maine | Office $115.39 | Facility $96.64 |
| Rest Of Maryland | Office $124.62 | Facility $104.00 |
| Rest Of Massachusetts | Office $127.77 | Facility $106.32 |
| Rest Of Michigan | Office $116.84 | Facility $98.23 |
| Rest Of Missouri | Office $111.96 | Facility $94.39 |
| Rest Of New Jersey | Office $133.10 | Facility $110.85 |
| Rest Of New York | Office $118.22 | Facility $98.86 |
| Rest Of Oregon | Office $122.06 | Facility $101.77 |
| Rest Of Pennsylvania | Office $116.52 | Facility $97.81 |
| Rest Of Texas | Office $118.94 | Facility $99.60 |
| Rest Of Washington | Office $127.52 | Facility $106.07 |
| Rhode Island | Office $126.59 | Facility $105.54 |
| Riverside-San Bernardino-Ontario | Office $131.66 | Facility $109.33 |
| Sacramento-Roseville-Folsom | Office $136.63 | Facility $112.94 |
| Salinas | Office $136.12 | Facility $112.50 |
| San Diego-Chula Vista-Carlsbad | Office $139.20 | Facility $114.83 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office $159.08 | Facility $130.35 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office $158.94 | Facility $130.21 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office $162.60 | Facility $133.22 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office $162.04 | Facility $132.66 |
| San Luis Obispo-Paso Robles | Office $133.94 | Facility $110.74 |
| Santa Cruz-Watsonville | Office $140.43 | Facility $115.68 |
| Santa Maria-Santa Barbara | Office $136.59 | Facility $112.84 |
| Santa Rosa-Petaluma | Office $141.84 | Facility $116.82 |
| Seattle (King Cnty) | Office $143.61 | Facility $118.61 |
| South Carolina | Office $116.64 | Facility $97.81 |
| South Dakota** | Office $120.92 | Facility $100.55 |
| Southern Maine | Office $121.35 | Facility $101.16 |
| Stockton | Office $130.35 | Facility $108.02 |
| Suburban Chicago | Office $129.18 | Facility $108.26 |
| Tennessee | Office $114.13 | Facility $95.61 |
| Utah | Office $118.16 | Facility $99.01 |
| Vallejo | Office $150.24 | Facility $123.39 |
| Vermont | Office $120.77 | Facility $100.60 |
| Virgin Islands | Office $124.44 | Facility $103.84 |
| Virginia | Office $120.99 | Facility $100.96 |
| Visalia | Office $130.35 | Facility $108.02 |
| West Virginia | Office $114.37 | Facility $96.67 |
| Wisconsin | Office $117.30 | Facility $97.78 |
| Wyoming** | Office $122.54 | Facility $102.17 |
| Yuba City | Office $130.35 | Facility $108.02 |
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
28530 billing questions
How is 28530 different from 28531?
28530 is for closed treatment of a sesamoid fracture without manipulation. Choose 28531 when the provider manipulates the fracture.
Can this code be used for a great toe phalanx fracture?
No. 28530 is for a sesamoid fracture. A fracture of a toe phalanx is coded from the toe-fracture family, based on the bone and treatment performed.
Are related postoperative visits included?
Yes. CMS assigns 28530 a 90-day global period that includes the day-before preoperative visit and 90 days of related postoperative care.
How is bilateral treatment reported?
CMS identifies this as a bilateral procedure; modifier 50 is paid at 150%. Document treatment of both sides.
When is assistant-at-surgery payment allowed?
CMS allows assistant-at-surgery payment only when medical necessity is documented. Co-surgeons and team surgery are not permitted.
What happens when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
3,22028510,,Treatment of toe fracture,A,,1.14,2.63,,2.45,,0.15,3.92,3.74,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,22128515,,Treatment of toe fracture,A,,1.52,3.52,,2.64,,0.18,5.22,4.34,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,22228525,,Treat toe fracture,A,,5.48,11.00,,5.38,,0.69,17.17,11.55,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,22328530,,Treat sesamoid bone fracture,A,,1.08,2.50,,1.89,,0.12,3.70,3.09,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,22428531,,Treat sesamoid bone fracture,A,,2.51,6.96,,2.51,,0.21,9.68,5.23,0,090,0.10,0.69,0.21,2,1,1,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,22528540,,Treat foot dislocation,A,,2.14,3.64,,2.80,,0.18,5.96,5.12,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,22628545,,Treat foot dislocation,A,,2.54,7.33,,5.23,,0.53,10.40,8.30,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00