Billing code 28126: Toe bone excisionMedicare rate & RVUs in Chicago
Reports complete excision of a toe phalanx, such as for a bone problem requiring removal of the phalanx while preserving the toe.
In Chicago, Medicare pays $405.66 for 28126 in the office and $255.95 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 28126 nationwide
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 11 sections
What 28126 covers
This procedure removes an entire phalanx—the bone segment in a toe—while leaving the toe itself in place. A foot and ankle surgeon, podiatrist, or other qualified surgeon may perform it for conditions such as bone infection or a painful deformity when complete removal of that phalanx is part of the operative plan. The operative report should identify the toe and phalanx and make clear that the entire phalanx, rather than only part of it, was excised.
Report the code for complete phalanx excision; partial removal belongs to a different code. 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. Medicare does not pay an assistant at surgery, and 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.
How Chicago compares for 28126
Across 109 of 109 payment localities, the office rate for 28126 runs from $344.89 in Arkansas to $507.36 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). Chicago pays $405.66. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Chicago · this page$405.66
- East St. Louis · Illinois$379.52−$26.14
- Rest Of Illinois · Illinois$372.00−$33.66
- Suburban Chicago · Illinois$404.65−$1.01
- Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) · California$434.53+$28.87
- Dc + Md/Va Suburbs · District of Columbia$440.50+$34.84
- Miami · Florida$417.01+$11.35
Other areas in Illinois first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| ManhattanNew York | $443.59 | $270.49 |
| Alaska*Alaska | $457.33 | $298.68 |
| AlabamaAlabama | $349.63 | $219.28 |
| ArkansasArkansas | $344.89 | $216.92 |
| ArizonaArizona | $377.36 | $233.01 |
| BakersfieldCalifornia | $408.97 | $245.70 |
| ChicoCalifornia | $407.80 | $244.54 |
| El CentroCalifornia | $407.87 | $244.60 |
| FresnoCalifornia | $407.80 | $244.54 |
| Hanford-CorcoranCalifornia | $407.80 | $244.54 |
| MaderaCalifornia | $407.80 | $244.54 |
| MercedCalifornia | $407.80 | $244.54 |
| ModestoCalifornia | $407.80 | $244.54 |
| NapaCalifornia | $469.70 | $273.36 |
| Oxnard-Thousand Oaks-VenturaCalifornia | $432.22 | $256.14 |
| ReddingCalifornia | $407.80 | $244.54 |
| Rest Of CaliforniaCalifornia | $407.80 | $244.54 |
| Riverside-San Bernardino-OntarioCalifornia | $411.95 | $248.68 |
| Sacramento-Roseville-FolsomCalifornia | $427.20 | $253.95 |
| SalinasCalifornia | $425.58 | $252.93 |
| San Diego-Chula Vista-CarlsbadCalifornia | $435.01 | $256.84 |
| San Francisco-Oakland-Berkeley (Marin Cnty)California | $496.41 | $286.37 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)California | $495.98 | $285.94 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty)California | $507.36 | $292.54 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)California | $505.59 | $290.78 |
| San Luis Obispo-Paso RoblesCalifornia | $418.81 | $249.13 |
| Santa Cruz-WatsonvilleCalifornia | $438.73 | $257.73 |
| Santa Maria-Santa BarbaraCalifornia | $427.02 | $253.32 |
| Santa Rosa-PetalumaCalifornia | $443.12 | $260.19 |
| StocktonCalifornia | $407.80 | $244.54 |
| VallejoCalifornia | $469.08 | $272.74 |
| VisaliaCalifornia | $407.80 | $244.54 |
| Yuba CityCalifornia | $407.80 | $244.54 |
| ColoradoColorado | $402.13 | $243.63 |
| ConnecticutConnecticut | $411.85 | $251.42 |
| DelawareDelaware | $383.36 | $236.18 |
| Fort LauderdaleFlorida | $400.70 | $249.79 |
| Rest Of FloridaFlorida | $382.24 | $239.83 |
| AtlantaGeorgia | $394.12 | $242.77 |
| Rest Of GeorgiaGeorgia | $361.92 | $229.04 |
| Hawaii, GuamHawaii | $416.82 | $247.45 |
| IowaIowa | $357.72 | $221.41 |
| IdahoIdaho | $359.96 | $222.91 |
| IndianaIndiana | $361.92 | $223.82 |
| KansasKansas | $356.26 | $221.59 |
| KentuckyKentucky | $357.64 | $225.21 |
| New OrleansLouisiana | $373.75 | $233.57 |
| Rest Of LouisianaLouisiana | $357.16 | $225.32 |
| Metropolitan BostonMassachusetts | $440.22 | $262.35 |
| Rest Of MassachusettsMassachusetts | $400.00 | $243.13 |
| Baltimore/Surr. CntysMaryland | $410.70 | $250.86 |
| Rest Of MarylandMaryland | $390.33 | $239.58 |
| Rest Of MaineMaine | $361.85 | $224.80 |
| Southern MaineMaine | $380.13 | $232.50 |
| DetroitMichigan | $386.87 | $243.11 |
| Rest Of MichiganMichigan | $366.49 | $230.49 |
| MinnesotaMinnesota | $385.60 | $232.31 |
| Metropolitan Kansas CityMissouri | $371.22 | $231.34 |
| Metropolitan St. LouisMissouri | $374.86 | $233.04 |
| Rest Of MissouriMissouri | $351.48 | $223.07 |
| MississippiMississippi | $348.24 | $219.98 |
| Montana**Montana | $387.09 | $238.12 |
| North CarolinaNorth Carolina | $365.39 | $226.41 |
| North Dakota**North Dakota | $379.58 | $230.61 |
| NebraskaNebraska | $359.52 | $222.02 |
| New HampshireNew Hampshire | $396.02 | $240.94 |
| Northern NjNew Jersey | $436.39 | $263.58 |
| Rest Of New JerseyNew Jersey | $416.63 | $253.96 |
| New MexicoNew Mexico | $368.43 | $231.83 |
| Nevada**Nevada | $385.25 | $236.14 |
| Nyc Suburbs/Long IslandNew York | $453.94 | $276.82 |
| Poughkpsie/N Nyc SuburbsNew York | $419.42 | $256.30 |
| QueensNew York | $446.88 | $270.80 |
| Rest Of New YorkNew York | $370.55 | $229.03 |
| OhioOhio | $364.96 | $228.95 |
| OklahomaOklahoma | $356.91 | $223.88 |
| PortlandOregon | $414.16 | $248.66 |
| Rest Of OregonOregon | $382.32 | $233.95 |
| Metropolitan PhiladelphiaPennsylvania | $402.19 | $247.11 |
| Rest Of PennsylvaniaPennsylvania | $365.44 | $228.69 |
| Puerto RicoPuerto Rico | $389.74 | $239.13 |
| Rhode IslandRhode Island | $396.44 | $242.56 |
| South CarolinaSouth Carolina | $365.77 | $228.12 |
| South Dakota**South Dakota | $378.69 | $229.72 |
| TennesseeTennessee | $357.96 | $222.55 |
| AustinTexas | $400.75 | $243.14 |
| BeaumontTexas | $363.19 | $227.63 |
| BrazoriaTexas | $382.97 | $235.34 |
| DallasTexas | $385.36 | $236.99 |
| Fort WorthTexas | $382.96 | $236.08 |
| GalvestonTexas | $384.09 | $236.17 |
| HoustonTexas | $391.05 | $243.12 |
| Rest Of TexasTexas | $372.84 | $231.47 |
| UtahUtah | $370.47 | $230.44 |
| VirginiaVirginia | $379.04 | $232.60 |
| Virgin IslandsUnited States Virgin Islands | $389.74 | $239.13 |
| VermontVermont | $378.29 | $230.81 |
| Rest Of WashingtonWashington | $399.18 | $242.32 |
| Seattle (King Cnty)Washington | $448.80 | $266.02 |
| WisconsinWisconsin | $367.59 | $224.88 |
| West VirginiaWest Virginia | $359.07 | $229.62 |
| Wyoming**Wyoming | $383.82 | $234.85 |
28126 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.
$344.89
$457.58
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 | $457.33 | 1 |
| AL | $349.63 | 1 |
| AR | $344.89 | 1 |
| AZ | $377.36 | 1 |
| CA | $407.80–$507.36 | 29 |
| CO | $402.13 | 1 |
| CT | $411.85 | 1 |
| DC | $440.50 | 1 |
| DE | $383.36 | 1 |
| FL | $382.24–$417.01 | 3 |
| GA | $361.92–$394.12 | 2 |
| GU | $416.82 | 1 |
| HI | $416.82 | 1 |
| IA | $357.72 | 1 |
| ID | $359.96 | 1 |
| IL | $372.00–$405.66 | 4 |
| IN | $361.92 | 1 |
| KS | $356.26 | 1 |
| KY | $357.64 | 1 |
| LA | $357.16–$373.75 | 2 |
| MA | $400.00–$440.22 | 2 |
| MD | $390.33–$440.50 | 3 |
| ME | $361.85–$380.13 | 2 |
| MI | $366.49–$386.87 | 2 |
| MN | $385.60 | 1 |
| MO | $351.48–$374.86 | 3 |
| MS | $348.24 | 1 |
| MT | $387.09 | 1 |
| NC | $365.39 | 1 |
| ND | $379.58 | 1 |
| NE | $359.52 | 1 |
| NH | $396.02 | 1 |
| NJ | $416.63–$436.39 | 2 |
| NM | $368.43 | 1 |
| NV | $385.25 | 1 |
| NY | $370.55–$453.94 | 5 |
| OH | $364.96 | 1 |
| OK | $356.91 | 1 |
| OR | $382.32–$414.16 | 2 |
| PA | $365.44–$402.19 | 2 |
| PR | $389.74 | 1 |
| RI | $396.44 | 1 |
| SC | $365.77 | 1 |
| SD | $378.69 | 1 |
| TN | $357.96 | 1 |
| TX | $363.19–$400.75 | 8 |
| UT | $370.47 | 1 |
| VA | $379.04–$440.50 | 2 |
| VI | $389.74 | 1 |
| VT | $378.29 | 1 |
| WA | $399.18–$448.80 | 2 |
| WI | $367.59 | 1 |
| WV | $359.07 | 1 |
| WY | $383.82 | 1 |
How the 28126 rate is calculated
Each of 28126’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 · 28126
RVUs × geographic indexes × conversion factor
Work3.55
3.55 RVUs× 1.000 GPCI
Practice expense7.66
7.66 RVUs× 1.000 GPCI
Malpractice0.38
0.38 RVUs× 1.000 GPCI
Adjusted RVUs
11.5900
Conversion factor
$33.4009
Medicare rate
$387.12
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Chicago inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
3,135
- Code
- 28126
- Physician work
- 3.55
- Practice expense
- 7.66
- Malpractice
- 0.38
GPCI2026.csv
48
- Locality
- Chicago
- Physician work
- 1.007
- Practice expense
- 1.005
- Malpractice
- 2.295
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.55 | × 1.007 | 3.5748 |
| Practice expense | 7.66 | × 1.005 | 7.6983 |
| Malpractice | 0.38 | × 2.295 | 0.8721 |
| Total RVUs | 12.1452 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Chicago$405.66
Office: (3.55 × 1.007 + 7.66 × 1.005 + 0.38 × 2.295) × $33.4009 = $405.66
Facility: (3.55 × 1.007 + 3.2 × 1.005 + 0.38 × 2.295) × $33.4009 = $255.95
Payment rules and modifiers for 28126
28126 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 28126
Toe bone 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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| 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 · 28126
Toe bone 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 51 · payment effect
With and without the modifier
28126 without 51 · national office
$387.12
Toe bone excision
28126-51 · Second procedure: 50%
$193.56
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
How 28126 has changed in Chicago
28126 · Office / nonfacility
$405.66
Effective 2026-10-01
The base rate is $10.15 higher than on 2025-10-01, moving from $395.51 to $405.66 (2.6%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$395.51changed to$405.66
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 3.64 changed to 3.55
- Practice expense RVU 7.60 changed to 7.66
- Malpractice RVU 0.39 changed to 0.38
- Practice expense GPCI 1.023 changed to 1.005
- Malpractice GPCI 2.018 changed to 2.295
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
Earliest loaded release: $395.51
Held through RVU25B, RVU25C, RVU25D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $405.66 | $255.95 | RVU26D |
| 2026-07-01 | $405.66 | $255.95 | RVU26C |
| 2026-04-01 | $405.66 | $255.95 | RVU26B |
| 2026-01-01 | $405.66 | $255.95 | RVU26A |
| 2025-10-01 | $395.51 | $263.15 | RVU25D |
| 2025-07-01 | $395.51 | $263.15 | RVU25C |
| 2025-04-01 | $395.51 | $263.15 | RVU25B |
| 2025-01-01 | $395.51 | $263.15 | RVU25A |
Where the Chicago rate applies
Chicago is a Medicare payment area, not a city. Our Census mapping connects it to 137 cities and communities in Illinois. Some span more than one payment area; confirm with the service ZIP.
- 28126 in Chicago · multiple payment areas
- 28126 in Alsip
- 28126 in Arlington Heights
- 28126 in Barrington · multiple payment areas
- 28126 in Barrington Hills · multiple payment areas
- 28126 in Bartlett · multiple payment areas
- 28126 in Bedford Park
- 28126 in Bellwood
28126 billing questions
How does this differ from 28124?
28126 describes complete excision of a toe phalanx. Use 28124 when the operative work is a partial excision instead.
Is this a toe amputation?
No. It describes removal of a phalanx, not removal of the toe as a whole.
What documentation supports reporting 28126?
The operative report should identify the toe and phalanx treated and document complete excision, rather than partial bone removal.
Can modifier 50 be used when both feet are treated?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
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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