Billing code 28645: Toe dislocation repairMedicare rate & RVUs

Medicare pays $666.35 for 28645 nationally in the office and $461.27 in a hospital or facility. Local office rates run $596.20–$853.24.

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

What 28645 covers

This service treats a dislocation of a toe’s metatarsophalangeal joint through an open surgical approach. The surgeon exposes the joint, restores alignment, and addresses the dislocation; internal fixation may be used when needed. Orthopedic surgeons and podiatric surgeons commonly perform the procedure in an operating room, often when the joint requires open treatment rather than closed reduction.

Report the code for open treatment of a metatarsophalangeal dislocation, not for closed reduction or for an open dislocation of an interphalangeal joint. The operative note should identify the affected toe and joint, describe the open approach and treatment, and document any fixation. Medicare 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 the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. 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 28645 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

28645 rates by state

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

How the 28645 rate is calculated

Each of 28645’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 28645

28645 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

28645 compared with similar codes

How to choose

28636Toe dislocation

Choose 28645 for open treatment of the metatarsophalangeal joint. Choose 28636 when the dislocation is treated closed with percutaneous skeletal fixation.

28635Toe dislocation

Code 28635 describes closed treatment of a metatarsophalangeal dislocation with anesthesia; 28645 is for open surgical treatment.

28675Toe dislocation repair

Both involve open treatment, but 28675 is for an interphalangeal joint dislocation. Code 28645 is for a metatarsophalangeal joint dislocation.

Codes related to 28645

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