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CMS RVU26D · Effective 2026-10-01

28530 in Chico

Office / nonfacility

$130.35

Base rate per service

Facility setting

$108.02

Base rate per service

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.

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 rates for Chico, from the same CMS release.

28531

Sesamoid fracture

Open treatment

$343.81

Both codes address closed treatment of a sesamoid fracture. Use 28530 when the fragments are not manipulated and 28531 when the provider manipulates them.

28510

Toe fracture care

Without manipulation

$137.69

28510 is for a lesser-toe phalanx fracture treated closed without manipulation. 28530 is for the sesamoid, not a toe phalanx.

28490

Toe fracture care

Without manipulation

$167.70

28490 concerns a great-toe phalanx fracture treated closed without manipulation. Choose 28530 when the injured bone is a sesamoid.

28505

Toe fracture surgery

Great toe, open treatment

$695.61

28505 describes open treatment of a great-toe fracture. 28530 is closed treatment of a sesamoid fracture without manipulation.

The same code, a different location

How does Chico compare?

In Bakersfield, the office rate for 28530 is $130.72—$0.37 higher than the $130.35 rate in Chico. Both use the same code, release and participation basis.

28530 across payment areas

Same release and payment basis · bars start at $0

  1. Chico · This locality

    $130.35

  2. $0.37 higher than Chico

  3. El Centro

    $130.37

    $0.02 higher than Chico

  4. Fresno

    $130.35

    The same base rate than Chico

  5. The same base rate than Chico

  6. $8.65 higher than Chico

  7. Madera

    $130.35

    The same base rate than Chico

Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 28530 ranges from $109.87 in Arkansas to $162.60 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). This is a geographic range, not an average.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas
  • Merced

    California · 28530

    Office

    $130.35

    Facility

    $108.02

    The same base rate than Chico for the office setting.

  • Modesto

    California · 28530

    Office

    $130.35

    Facility

    $108.02

    The same base rate than Chico for the office setting.

  • Napa

    California · 28530

    Office

    $150.44

    Facility

    $123.58

    $20.09 higher than Chico for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 28530

    Office

    $138.28

    Facility

    $114.20

    $7.93 higher than Chico for the office setting.

  • Redding

    California · 28530

    Office

    $130.35

    Facility

    $108.02

    The same base rate than Chico for the office setting.

  • Rest Of California

    California · 28530

    Office

    $130.35

    Facility

    $108.02

    The same base rate than Chico for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 28530

    Office

    $131.66

    Facility

    $109.33

    $1.31 higher than Chico for the office setting.

  • Sacramento-Roseville-Folsom

    California · 28530

    Office

    $136.63

    Facility

    $112.94

    $6.28 higher than Chico for the office setting.

  • Salinas

    California · 28530

    Office

    $136.12

    Facility

    $112.50

    $5.77 higher than Chico for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 28530

    Office

    $139.20

    Facility

    $114.83

    $8.85 higher than Chico for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 28530

    Office

    $159.08

    Facility

    $130.35

    $28.73 higher than Chico for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 28530

    Office

    $158.94

    Facility

    $130.21

    $28.59 higher than Chico for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 28530

    Office

    $162.60

    Facility

    $133.22

    $32.25 higher than Chico for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 28530

    Office

    $162.04

    Facility

    $132.66

    $31.69 higher than Chico for the office setting.

  • San Luis Obispo-Paso Robles

    California · 28530

    Office

    $133.94

    Facility

    $110.74

    $3.59 higher than Chico for the office setting.

  • Santa Cruz-Watsonville

    California · 28530

    Office

    $140.43

    Facility

    $115.68

    $10.08 higher than Chico for the office setting.

  • Santa Maria-Santa Barbara

    California · 28530

    Office

    $136.59

    Facility

    $112.84

    $6.24 higher than Chico for the office setting.

  • Santa Rosa-Petaluma

    California · 28530

    Office

    $141.84

    Facility

    $116.82

    $11.49 higher than Chico for the office setting.

  • Stockton

    California · 28530

    Office

    $130.35

    Facility

    $108.02

    The same base rate than Chico for the office setting.

  • Vallejo

    California · 28530

    Office

    $150.24

    Facility

    $123.39

    $19.89 higher than Chico for the office setting.

  • Visalia

    California · 28530

    Office

    $130.35

    Facility

    $108.02

    The same base rate than Chico for the office setting.

  • Yuba City

    California · 28530

    Office

    $130.35

    Facility

    $108.02

    The same base rate than Chico for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 28530

    Office

    $140.85

    Facility

    $116.85

    $10.50 higher than Chico for the office setting.

  • Miami

    Florida · 28530

    Office

    $133.14

    Facility

    $111.93

    $2.79 higher than Chico for the office setting.

  • Chicago

    Illinois · 28530

    Office

    $129.44

    Facility

    $108.97

    $0.91 lower than Chico for the office setting.

  • Manhattan

    New York · 28530

    Office

    $141.77

    Facility

    $118.09

    $11.42 higher than Chico for the office setting.

  • Alaska*

    Alaska · 28530

    Office

    $145.25

    Facility

    $123.55

    $14.90 higher than Chico for the office setting.

  • Alabama

    Alabama · 28530

    Office

    $111.41

    Facility

    $93.58

    $18.94 lower than Chico for the office setting.

  • Arkansas

    Arkansas · 28530

    Office

    $109.87

    Facility

    $92.36

    $20.48 lower than Chico for the office setting.

  • Arizona

    Arizona · 28530

    Office

    $120.42

    Facility

    $100.67

    $9.93 lower than Chico for the office setting.

  • Colorado

    Colorado · 28530

    Office

    $128.48

    Facility

    $106.80

    $1.87 lower than Chico for the office setting.

  • Connecticut

    Connecticut · 28530

    Office

    $131.58

    Facility

    $109.63

    $1.23 higher than Chico for the office setting.

  • Delaware

    Delaware · 28530

    Office

    $122.36

    Facility

    $102.23

    $7.99 lower than Chico for the office setting.

  • Fort Lauderdale

    Florida · 28530

    Office

    $127.91

    Facility

    $107.27

    $2.44 lower than Chico for the office setting.

  • Rest Of Florida

    Florida · 28530

    Office

    $121.93

    Facility

    $102.45

    $8.42 lower than Chico for the office setting.

  • Atlanta

    Georgia · 28530

    Office

    $125.83

    Facility

    $105.13

    $4.52 lower than Chico for the office setting.

  • Rest Of Georgia

    Georgia · 28530

    Office

    $115.33

    Facility

    $97.16

    $15.02 lower than Chico for the office setting.

  • Hawaii, Guam

    Hawaii · 28530

    Office

    $133.34

    Facility

    $110.17

    $2.99 higher than Chico for the office setting.

  • Iowa

    Iowa · 28530

    Office

    $114.07

    Facility

    $95.43

    $16.28 lower than Chico for the office setting.

  • Idaho

    Idaho · 28530

    Office

    $114.79

    Facility

    $96.05

    $15.56 lower than Chico for the office setting.

  • East St. Louis

    Illinois · 28530

    Office

    $120.97

    Facility

    $102.22

    $9.38 lower than Chico for the office setting.

  • Rest Of Illinois

    Illinois · 28530

    Office

    $118.58

    Facility

    $99.97

    $11.77 lower than Chico for the office setting.

  • Suburban Chicago

    Illinois · 28530

    Office

    $129.18

    Facility

    $108.26

    $1.17 lower than Chico for the office setting.

  • Indiana

    Indiana · 28530

    Office

    $115.43

    Facility

    $96.54

    $14.92 lower than Chico for the office setting.

  • Kansas

    Kansas · 28530

    Office

    $113.58

    Facility

    $95.16

    $16.77 lower than Chico for the office setting.

  • Kentucky

    Kentucky · 28530

    Office

    $113.97

    Facility

    $95.86

    $16.38 lower than Chico for the office setting.

  • New Orleans

    Louisiana · 28530

    Office

    $119.20

    Facility

    $100.03

    $11.15 lower than Chico for the office setting.

  • Rest Of Louisiana

    Louisiana · 28530

    Office

    $113.81

    Facility

    $95.78

    $16.54 lower than Chico for the office setting.

  • Metropolitan Boston

    Massachusetts · 28530

    Office

    $140.82

    Facility

    $116.49

    $10.47 higher than Chico for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 28530

    Office

    $127.77

    Facility

    $106.32

    $2.58 lower than Chico for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 28530

    Office

    $131.21

    Facility

    $109.34

    $0.86 higher than Chico for the office setting.

  • Rest Of Maryland

    Maryland · 28530

    Office

    $124.62

    Facility

    $104.00

    $5.73 lower than Chico for the office setting.

  • Rest Of Maine

    Maine · 28530

    Office

    $115.39

    Facility

    $96.64

    $14.96 lower than Chico for the office setting.

  • Southern Maine

    Maine · 28530

    Office

    $121.35

    Facility

    $101.16

    $9.00 lower than Chico for the office setting.

  • Detroit

    Michigan · 28530

    Office

    $123.41

    Facility

    $103.75

    $6.94 lower than Chico for the office setting.

  • Rest Of Michigan

    Michigan · 28530

    Office

    $116.84

    Facility

    $98.23

    $13.51 lower than Chico for the office setting.

  • Minnesota

    Minnesota · 28530

    Office

    $123.18

    Facility

    $102.22

    $7.17 lower than Chico for the office setting.

  • Metropolitan Kansas City

    Missouri · 28530

    Office

    $118.40

    Facility

    $99.27

    $11.95 lower than Chico for the office setting.

  • Metropolitan St. Louis

    Missouri · 28530

    Office

    $119.58

    Facility

    $100.19

    $10.77 lower than Chico for the office setting.

  • Rest Of Missouri

    Missouri · 28530

    Office

    $111.96

    Facility

    $94.39

    $18.39 lower than Chico for the office setting.

  • Mississippi

    Mississippi · 28530

    Office

    $110.93

    Facility

    $93.39

    $19.42 lower than Chico for the office setting.

  • Montana**

    Montana · 28530

    Office

    $123.58

    Facility

    $103.20

    $6.77 lower than Chico for the office setting.

  • North Carolina

    North Carolina · 28530

    Office

    $116.54

    Facility

    $97.53

    $13.81 lower than Chico for the office setting.

  • North Dakota**

    North Dakota · 28530

    Office

    $121.20

    Facility

    $100.83

    $9.15 lower than Chico for the office setting.

  • Nebraska

    Nebraska · 28530

    Office

    $114.66

    Facility

    $95.85

    $15.69 lower than Chico for the office setting.

  • New Hampshire

    New Hampshire · 28530

    Office

    $126.51

    Facility

    $105.30

    $3.84 lower than Chico for the office setting.

  • Northern Nj

    New Jersey · 28530

    Office

    $139.49

    Facility

    $115.85

    $9.14 higher than Chico for the office setting.

  • Rest Of New Jersey

    New Jersey · 28530

    Office

    $133.10

    Facility

    $110.85

    $2.75 higher than Chico for the office setting.

  • New Mexico

    New Mexico · 28530

    Office

    $117.46

    Facility

    $98.77

    $12.89 lower than Chico for the office setting.

  • Nevada**

    Nevada · 28530

    Office

    $123.00

    Facility

    $102.60

    $7.35 lower than Chico for the office setting.

  • Nyc Suburbs/Long Island

    New York · 28530

    Office

    $145.11

    Facility

    $120.88

    $14.76 higher than Chico for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 28530

    Office

    $133.98

    Facility

    $111.67

    $3.63 higher than Chico for the office setting.

  • Queens

    New York · 28530

    Office

    $142.86

    Facility

    $118.78

    $12.51 higher than Chico for the office setting.

  • Rest Of New York

    New York · 28530

    Office

    $118.22

    Facility

    $98.86

    $12.13 lower than Chico for the office setting.

  • Ohio

    Ohio · 28530

    Office

    $116.35

    Facility

    $97.75

    $14.00 lower than Chico for the office setting.

  • Oklahoma

    Oklahoma · 28530

    Office

    $113.75

    Facility

    $95.56

    $16.60 lower than Chico for the office setting.

  • Portland

    Oregon · 28530

    Office

    $132.40

    Facility

    $109.77

    $2.05 higher than Chico for the office setting.

  • Rest Of Oregon

    Oregon · 28530

    Office

    $122.06

    Facility

    $101.77

    $8.29 lower than Chico for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 28530

    Office

    $128.43

    Facility

    $107.22

    $1.92 lower than Chico for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 28530

    Office

    $116.52

    Facility

    $97.81

    $13.83 lower than Chico for the office setting.

  • Puerto Rico

    Puerto Rico · 28530

    Office

    $124.44

    Facility

    $103.84

    $5.91 lower than Chico for the office setting.

  • Rhode Island

    Rhode Island · 28530

    Office

    $126.59

    Facility

    $105.54

    $3.76 lower than Chico for the office setting.

  • South Carolina

    South Carolina · 28530

    Office

    $116.64

    Facility

    $97.81

    $13.71 lower than Chico for the office setting.

  • South Dakota**

    South Dakota · 28530

    Office

    $120.92

    Facility

    $100.55

    $9.43 lower than Chico for the office setting.

  • Tennessee

    Tennessee · 28530

    Office

    $114.13

    Facility

    $95.61

    $16.22 lower than Chico for the office setting.

  • Austin

    Texas · 28530

    Office

    $128.04

    Facility

    $106.49

    $2.31 lower than Chico for the office setting.

  • Beaumont

    Texas · 28530

    Office

    $115.78

    Facility

    $97.24

    $14.57 lower than Chico for the office setting.

  • Brazoria

    Texas · 28530

    Office

    $122.24

    Facility

    $102.05

    $8.11 lower than Chico for the office setting.

  • Dallas

    Texas · 28530

    Office

    $123.00

    Facility

    $102.71

    $7.35 lower than Chico for the office setting.

  • Fort Worth

    Texas · 28530

    Office

    $122.22

    Facility

    $102.13

    $8.13 lower than Chico for the office setting.

  • Galveston

    Texas · 28530

    Office

    $122.60

    Facility

    $102.37

    $7.75 lower than Chico for the office setting.

  • Houston

    Texas · 28530

    Office

    $124.79

    Facility

    $104.56

    $5.56 lower than Chico for the office setting.

  • Rest Of Texas

    Texas · 28530

    Office

    $118.94

    Facility

    $99.60

    $11.41 lower than Chico for the office setting.

  • Utah

    Utah · 28530

    Office

    $118.16

    Facility

    $99.01

    $12.19 lower than Chico for the office setting.

  • Virginia

    Virginia · 28530

    Office

    $120.99

    Facility

    $100.96

    $9.36 lower than Chico for the office setting.

  • Virgin Islands

    United States Virgin Islands · 28530

    Office

    $124.44

    Facility

    $103.84

    $5.91 lower than Chico for the office setting.

  • Vermont

    Vermont · 28530

    Office

    $120.77

    Facility

    $100.60

    $9.58 lower than Chico for the office setting.

  • Rest Of Washington

    Washington · 28530

    Office

    $127.52

    Facility

    $106.07

    $2.83 lower than Chico for the office setting.

  • Seattle (King Cnty)

    Washington · 28530

    Office

    $143.61

    Facility

    $118.61

    $13.26 higher than Chico for the office setting.

  • Wisconsin

    Wisconsin · 28530

    Office

    $117.30

    Facility

    $97.78

    $13.05 lower than Chico for the office setting.

  • West Virginia

    West Virginia · 28530

    Office

    $114.37

    Facility

    $96.67

    $15.98 lower than Chico for the office setting.

  • Wyoming**

    Wyoming · 28530

    Office

    $122.54

    Facility

    $102.17

    $7.81 lower than Chico for the office setting.

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 / territoryRate rangeLocalities
AK$145.251
AL$111.411
AR$109.871
AZ$120.421
CA$130.35–$162.6029
CO$128.481
CT$131.581
DC$140.851
DE$122.361
FL$121.93–$133.143
GA$115.33–$125.832
GU$133.341
HI$133.341
IA$114.071
ID$114.791
IL$118.58–$129.444
IN$115.431
KS$113.581
KY$113.971
LA$113.81–$119.202
MA$127.77–$140.822
MD$124.62–$140.853
ME$115.39–$121.352
MI$116.84–$123.412
MN$123.181
MO$111.96–$119.583
MS$110.931
MT$123.581
NC$116.541
ND$121.201
NE$114.661
NH$126.511
NJ$133.10–$139.492
NM$117.461
NV$123.001
NY$118.22–$145.115
OH$116.351
OK$113.751
OR$122.06–$132.402
PA$116.52–$128.432
PR$124.441
RI$126.591
SC$116.641
SD$120.921
TN$114.131
TX$115.78–$128.048
UT$118.161
VA$120.99–$140.852
VI$124.441
VT$120.771
WA$127.52–$143.612
WI$117.301
WV$114.371
WY$122.541

Explore 28530 on the national rate map →

Where does this rate apply?

Chico is a Medicare payment area. Our Census mapping connects it to 30 cities and communities in California, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Why are the office and facility amounts different?

For 28530 in Chico, the physician’s office rate is $130.35 and the facility-setting rate is $108.02: a difference of $22.33.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 28530 in Chico. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$143.39

$130.35 × 110% = $143.39

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

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How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 28530 in Chico.

PPRRVU2026_Oct_nonQPP.csv

3,223

Code
28530
Physician work
1.08
Practice expense
2.50
Malpractice
0.12

GPCI2026.csv

9

Locality
Chico
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Office / nonfacility calculation for 28530 in Chico
ComponentRVULocality factorAdjusted
Physician work1.08× 1.0171.0984
Practice expense2.50× 1.0962.7400
Malpractice0.12× 0.5360.0643
Total RVUs3.9027
Conversion factor× 33.4009

Office / nonfacility rate, Chico$130.35

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.

Open 28530 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work1.081.017
Practice expense2.51.096
Malpractice0.120.536

(1.08 × 1.017 + 2.5 × 1.096 + 0.12 × 0.536) × $33.4009 = $130.35

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work1.081.017
Practice expense1.891.096
Malpractice0.120.536

(1.08 × 1.017 + 1.89 × 1.096 + 0.12 × 0.536) × $33.4009 = $108.02

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

28530 · Office / nonfacility

$130.35

Effective 2026-10-01

The base rate is $4.62 higher than on 2025-10-01, moving from $125.73 to $130.35 (3.7%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

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

  1. January 1, 2026

    RVU26A

    $125.73changed to$130.35

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.11 changed to 1.08
    • Practice expense RVU 2.46 changed to 2.50
    • Malpractice RVU 0.13 changed to 0.12
    • Work GPCI 1.014 changed to 1.017
    • Practice expense GPCI 1.093 changed to 1.096
    • Malpractice GPCI 0.560 changed to 0.536

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $125.73

    Held through RVU25B, RVU25C, RVU25D.

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$130.35$108.02RVU26D
2026-07-01$130.35$108.02RVU26C
2026-04-01$130.35$108.02RVU26B
2026-01-01$130.35$108.02RVU26A
2025-10-01$125.73$109.83RVU25D
2025-07-01$125.73$109.83RVU25C
2025-04-01$125.73$109.83RVU25B
2025-01-01$125.73$109.83RVU25A

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.

RVUs for 28530PPRRVU2026_Oct_nonQPP.csv, line 3,223 (RVU26D)
Geographic factors for ChicoGPCI2026.csv, line 9 (RVU26D)