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CMS RVU26D · Effective 2026-10-01

28495 in Delaware

Office / nonfacility

$193.72

Base rate per service

Facility setting

$152.80

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.

Fracture treatment

About 28495: Great toe fracture closed reduction

Closed reduction and treatment of a great-toe phalanx fracture when the provider manipulates the fracture without open exposure or percutaneous fixation.

Code 28495 represents closed treatment of a fracture in a great-toe phalanx when the clinician manipulates the fracture to restore alignment. The provider may use manual reduction and then immobilize the toe, such as with taping, a rigid-soled shoe, or a splint. Typical cases include a displaced hallux phalanx fracture managed without an incision or percutaneous hardware. Orthopedic surgeons, podiatrists, and other clinicians qualified to manage fractures may perform this service in an office, emergency department, or facility setting.

Report the code for a great-toe phalanx fracture and document the fracture site and manipulation performed. CMS assigns a 90-day major-surgery global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. CMS does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.

CMS billing rules for 28495

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
Statutory restriction: assistant at surgery is not paid.
Co-surgeons
Co-surgeons not permitted.
Team surgery
Team surgery not permitted.

Where the value comes from

  • Work RVU1.64 · 28%
  • Practice expense (office) RVU4.02 · 69%
  • Malpractice RVU0.20 · 3%

238

Medicare services in 2024 · #4171 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.

28495 compared with similar codes

Office rates for Delaware, from the same CMS release.

28490

Toe fracture care

Without manipulation

$156.89

Both codes treat great-toe phalanx fractures without open exposure. Choose 28495 when the provider manipulates the fracture; 28490 is for treatment without manipulation.

28496

Great toe fracture

Percutaneous fixation with manipulation

$541.75

28496 includes percutaneous skeletal fixation with manipulation. Use 28495 for closed treatment with manipulation when that fixation is not performed.

28475

Metatarsal fracture

Closed reduction, each bone

$273.09

28475 concerns a metatarsal fracture treated with manipulation, not a phalanx fracture of the great toe.

The same code, a different location

How does Delaware compare?

28495 across payment areas

Same release and payment basis · bars start at $0

  1. Delaware · This locality

    $193.72

  2. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    $220.30

    $26.58 higher than Delaware

  3. Dc + Md/Va Suburbs

    $223.34

    $29.62 higher than Delaware

  4. Miami

    $211.45

    $17.73 higher than Delaware

  5. Chicago

    $205.43

    $11.71 higher than Delaware

  6. Manhattan

    $224.90

    $31.18 higher than Delaware

  7. Alaska*

    $228.85

    $35.13 higher than Delaware

Other payment areas listed in Delaware 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, 28495 ranges from $173.56 in Arkansas to $258.00 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

  • Alabama

    Alabama · 28495

    Office

    $176.05

    Facility

    $139.81

    $17.67 lower than Delaware for the office setting.

  • Arkansas

    Arkansas · 28495

    Office

    $173.56

    Facility

    $137.98

    $20.16 lower than Delaware for the office setting.

  • Arizona

    Arizona · 28495

    Office

    $190.60

    Facility

    $150.47

    $3.12 lower than Delaware for the office setting.

  • Bakersfield

    California · 28495

    Office

    $207.05

    Facility

    $161.66

    $13.33 higher than Delaware for the office setting.

  • Chico

    California · 28495

    Office

    $206.45

    Facility

    $161.06

    $12.73 higher than Delaware for the office setting.

  • El Centro

    California · 28495

    Office

    $206.48

    Facility

    $161.09

    $12.76 higher than Delaware for the office setting.

  • Fresno

    California · 28495

    Office

    $206.45

    Facility

    $161.06

    $12.73 higher than Delaware for the office setting.

  • Hanford-Corcoran

    California · 28495

    Office

    $206.45

    Facility

    $161.06

    $12.73 higher than Delaware for the office setting.

  • Madera

    California · 28495

    Office

    $206.45

    Facility

    $161.06

    $12.73 higher than Delaware for the office setting.

  • Merced

    California · 28495

    Office

    $206.45

    Facility

    $161.06

    $12.73 higher than Delaware for the office setting.

  • Modesto

    California · 28495

    Office

    $206.45

    Facility

    $161.06

    $12.73 higher than Delaware for the office setting.

  • Napa

    California · 28495

    Office

    $238.59

    Facility

    $184.00

    $44.87 higher than Delaware for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 28495

    Office

    $219.18

    Facility

    $170.23

    $25.46 higher than Delaware for the office setting.

  • Redding

    California · 28495

    Office

    $206.45

    Facility

    $161.06

    $12.73 higher than Delaware for the office setting.

  • Rest Of California

    California · 28495

    Office

    $206.45

    Facility

    $161.06

    $12.73 higher than Delaware for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 28495

    Office

    $208.62

    Facility

    $163.23

    $14.90 higher than Delaware for the office setting.

  • Sacramento-Roseville-Folsom

    California · 28495

    Office

    $216.49

    Facility

    $168.32

    $22.77 higher than Delaware for the office setting.

  • Salinas

    California · 28495

    Office

    $215.68

    Facility

    $167.67

    $21.96 higher than Delaware for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 28495

    Office

    $220.63

    Facility

    $171.10

    $26.91 higher than Delaware for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 28495

    Office

    $252.37

    Facility

    $193.97

    $58.65 higher than Delaware for the office setting.

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

    California · 28495

    Office

    $252.14

    Facility

    $193.75

    $58.42 higher than Delaware for the office setting.

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

    California · 28495

    Office

    $258.00

    Facility

    $198.28

    $64.28 higher than Delaware for the office setting.

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

    California · 28495

    Office

    $257.07

    Facility

    $197.35

    $63.35 higher than Delaware for the office setting.

  • San Luis Obispo-Paso Robles

    California · 28495

    Office

    $212.22

    Facility

    $165.05

    $18.50 higher than Delaware for the office setting.

  • Santa Cruz-Watsonville

    California · 28495

    Office

    $222.65

    Facility

    $172.33

    $28.93 higher than Delaware for the office setting.

  • Santa Maria-Santa Barbara

    California · 28495

    Office

    $216.45

    Facility

    $168.16

    $22.73 higher than Delaware for the office setting.

  • Santa Rosa-Petaluma

    California · 28495

    Office

    $224.89

    Facility

    $174.03

    $31.17 higher than Delaware for the office setting.

  • Stockton

    California · 28495

    Office

    $206.45

    Facility

    $161.06

    $12.73 higher than Delaware for the office setting.

  • Vallejo

    California · 28495

    Office

    $238.26

    Facility

    $183.68

    $44.54 higher than Delaware for the office setting.

  • Visalia

    California · 28495

    Office

    $206.45

    Facility

    $161.06

    $12.73 higher than Delaware for the office setting.

  • Yuba City

    California · 28495

    Office

    $206.45

    Facility

    $161.06

    $12.73 higher than Delaware for the office setting.

  • Colorado

    Colorado · 28495

    Office

    $203.52

    Facility

    $159.45

    $9.80 higher than Delaware for the office setting.

  • Connecticut

    Connecticut · 28495

    Office

    $208.57

    Facility

    $163.96

    $14.85 higher than Delaware for the office setting.

  • Fort Lauderdale

    Florida · 28495

    Office

    $202.87

    Facility

    $160.92

    $9.15 higher than Delaware for the office setting.

  • Rest Of Florida

    Florida · 28495

    Office

    $193.18

    Facility

    $153.59

    $0.54 lower than Delaware for the office setting.

  • Atlanta

    Georgia · 28495

    Office

    $199.38

    Facility

    $157.30

    $5.66 higher than Delaware for the office setting.

  • Rest Of Georgia

    Georgia · 28495

    Office

    $182.51

    Facility

    $145.57

    $11.21 lower than Delaware for the office setting.

  • Hawaii, Guam

    Hawaii · 28495

    Office

    $211.31

    Facility

    $164.22

    $17.59 higher than Delaware for the office setting.

  • Iowa

    Iowa · 28495

    Office

    $180.29

    Facility

    $142.39

    $13.43 lower than Delaware for the office setting.

  • Idaho

    Idaho · 28495

    Office

    $181.47

    Facility

    $143.36

    $12.25 lower than Delaware for the office setting.

  • East St. Louis

    Illinois · 28495

    Office

    $191.76

    Facility

    $153.66

    $1.96 lower than Delaware for the office setting.

  • Rest Of Illinois

    Illinois · 28495

    Office

    $187.81

    Facility

    $149.99

    $5.91 lower than Delaware for the office setting.

  • Suburban Chicago

    Illinois · 28495

    Office

    $204.90

    Facility

    $162.36

    $11.18 higher than Delaware for the office setting.

  • Indiana

    Indiana · 28495

    Office

    $182.49

    Facility

    $144.10

    $11.23 lower than Delaware for the office setting.

  • Kansas

    Kansas · 28495

    Office

    $179.53

    Facility

    $142.08

    $14.19 lower than Delaware for the office setting.

  • Kentucky

    Kentucky · 28495

    Office

    $180.26

    Facility

    $143.44

    $13.46 lower than Delaware for the office setting.

  • New Orleans

    Louisiana · 28495

    Office

    $188.72

    Facility

    $149.74

    $5.00 lower than Delaware for the office setting.

  • Rest Of Louisiana

    Louisiana · 28495

    Office

    $180.01

    Facility

    $143.35

    $13.71 lower than Delaware for the office setting.

  • Metropolitan Boston

    Massachusetts · 28495

    Office

    $223.29

    Facility

    $173.84

    $29.57 higher than Delaware for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 28495

    Office

    $202.37

    Facility

    $158.75

    $8.65 higher than Delaware for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 28495

    Office

    $207.99

    Facility

    $163.55

    $14.27 higher than Delaware for the office setting.

  • Rest Of Maryland

    Maryland · 28495

    Office

    $197.34

    Facility

    $155.43

    $3.62 higher than Delaware for the office setting.

  • Rest Of Maine

    Maine · 28495

    Office

    $182.46

    Facility

    $144.36

    $11.26 lower than Delaware for the office setting.

  • Southern Maine

    Maine · 28495

    Office

    $192.06

    Facility

    $151.01

    $1.66 lower than Delaware for the office setting.

  • Detroit

    Michigan · 28495

    Office

    $195.61

    Facility

    $155.64

    $1.89 higher than Delaware for the office setting.

  • Rest Of Michigan

    Michigan · 28495

    Office

    $184.91

    Facility

    $147.10

    $8.81 lower than Delaware for the office setting.

  • Minnesota

    Minnesota · 28495

    Office

    $194.92

    Facility

    $152.30

    $1.20 higher than Delaware for the office setting.

  • Metropolitan Kansas City

    Missouri · 28495

    Office

    $187.39

    Facility

    $148.49

    $6.33 lower than Delaware for the office setting.

  • Metropolitan St. Louis

    Missouri · 28495

    Office

    $189.30

    Facility

    $149.87

    $4.42 lower than Delaware for the office setting.

  • Rest Of Missouri

    Missouri · 28495

    Office

    $177.03

    Facility

    $141.32

    $16.69 lower than Delaware for the office setting.

  • Mississippi

    Mississippi · 28495

    Office

    $175.32

    Facility

    $139.66

    $18.40 lower than Delaware for the office setting.

  • Montana**

    Montana · 28495

    Office

    $195.72

    Facility

    $154.30

    $2.00 higher than Delaware for the office setting.

  • North Carolina

    North Carolina · 28495

    Office

    $184.32

    Facility

    $145.68

    $9.40 lower than Delaware for the office setting.

  • North Dakota**

    North Dakota · 28495

    Office

    $191.76

    Facility

    $150.34

    $1.96 lower than Delaware for the office setting.

  • Nebraska

    Nebraska · 28495

    Office

    $181.24

    Facility

    $143.01

    $12.48 lower than Delaware for the office setting.

  • New Hampshire

    New Hampshire · 28495

    Office

    $200.40

    Facility

    $157.28

    $6.68 higher than Delaware for the office setting.

  • Northern Nj

    New Jersey · 28495

    Office

    $221.12

    Facility

    $173.07

    $27.40 higher than Delaware for the office setting.

  • Rest Of New Jersey

    New Jersey · 28495

    Office

    $210.92

    Facility

    $165.69

    $17.20 higher than Delaware for the office setting.

  • New Mexico

    New Mexico · 28495

    Office

    $185.93

    Facility

    $147.95

    $7.79 lower than Delaware for the office setting.

  • Nevada**

    Nevada · 28495

    Office

    $194.75

    Facility

    $153.29

    $1.03 higher than Delaware for the office setting.

  • Nyc Suburbs/Long Island

    New York · 28495

    Office

    $230.34

    Facility

    $181.09

    $36.62 higher than Delaware for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 28495

    Office

    $212.35

    Facility

    $167.00

    $18.63 higher than Delaware for the office setting.

  • Queens

    New York · 28495

    Office

    $226.63

    Facility

    $177.67

    $32.91 higher than Delaware for the office setting.

  • Rest Of New York

    New York · 28495

    Office

    $187.03

    Facility

    $147.69

    $6.69 lower than Delaware for the office setting.

  • Ohio

    Ohio · 28495

    Office

    $184.10

    Facility

    $146.29

    $9.62 lower than Delaware for the office setting.

  • Oklahoma

    Oklahoma · 28495

    Office

    $179.87

    Facility

    $142.89

    $13.85 lower than Delaware for the office setting.

  • Portland

    Oregon · 28495

    Office

    $209.80

    Facility

    $163.79

    $16.08 higher than Delaware for the office setting.

  • Rest Of Oregon

    Oregon · 28495

    Office

    $193.21

    Facility

    $151.96

    $0.51 lower than Delaware for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 28495

    Office

    $203.51

    Facility

    $160.39

    $9.79 higher than Delaware for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 28495

    Office

    $184.35

    Facility

    $146.33

    $9.37 lower than Delaware for the office setting.

  • Puerto Rico

    Puerto Rico · 28495

    Office

    $197.11

    Facility

    $155.23

    $3.39 higher than Delaware for the office setting.

  • Rhode Island

    Rhode Island · 28495

    Office

    $200.48

    Facility

    $157.70

    $6.76 higher than Delaware for the office setting.

  • South Carolina

    South Carolina · 28495

    Office

    $184.52

    Facility

    $146.25

    $9.20 lower than Delaware for the office setting.

  • South Dakota**

    South Dakota · 28495

    Office

    $191.29

    Facility

    $149.88

    $2.43 lower than Delaware for the office setting.

  • Tennessee

    Tennessee · 28495

    Office

    $180.42

    Facility

    $142.77

    $13.30 lower than Delaware for the office setting.

  • Austin

    Texas · 28495

    Office

    $202.87

    Facility

    $159.05

    $9.15 higher than Delaware for the office setting.

  • Beaumont

    Texas · 28495

    Office

    $183.17

    Facility

    $145.48

    $10.55 lower than Delaware for the office setting.

  • Brazoria

    Texas · 28495

    Office

    $193.49

    Facility

    $152.45

    $0.23 lower than Delaware for the office setting.

  • Dallas

    Texas · 28495

    Office

    $194.74

    Facility

    $153.49

    $1.02 higher than Delaware for the office setting.

  • Fort Worth

    Texas · 28495

    Office

    $193.48

    Facility

    $152.64

    $0.24 lower than Delaware for the office setting.

  • Galveston

    Texas · 28495

    Office

    $194.08

    Facility

    $152.95

    $0.36 higher than Delaware for the office setting.

  • Houston

    Texas · 28495

    Office

    $197.74

    Facility

    $156.61

    $4.02 higher than Delaware for the office setting.

  • Rest Of Texas

    Texas · 28495

    Office

    $188.23

    Facility

    $148.93

    $5.49 lower than Delaware for the office setting.

  • Utah

    Utah · 28495

    Office

    $186.99

    Facility

    $148.06

    $6.73 lower than Delaware for the office setting.

  • Virginia

    Virginia · 28495

    Office

    $191.48

    Facility

    $150.77

    $2.24 lower than Delaware for the office setting.

  • Virgin Islands

    United States Virgin Islands · 28495

    Office

    $197.11

    Facility

    $155.23

    $3.39 higher than Delaware for the office setting.

  • Vermont

    Vermont · 28495

    Office

    $191.09

    Facility

    $150.08

    $2.63 lower than Delaware for the office setting.

  • Rest Of Washington

    Washington · 28495

    Office

    $201.96

    Facility

    $158.35

    $8.24 higher than Delaware for the office setting.

  • Seattle (King Cnty)

    Washington · 28495

    Office

    $227.73

    Facility

    $176.91

    $34.01 higher than Delaware for the office setting.

  • Wisconsin

    Wisconsin · 28495

    Office

    $185.47

    Facility

    $145.79

    $8.25 lower than Delaware for the office setting.

  • West Virginia

    West Virginia · 28495

    Office

    $181.02

    Facility

    $145.03

    $12.70 lower than Delaware for the office setting.

  • Wyoming**

    Wyoming · 28495

    Office

    $193.99

    Facility

    $152.58

    $0.27 higher than Delaware for the office setting.

See how rates vary across the country

28495 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

$173.56

$232.23

Color shows the midpoint of each state’s locality range.

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$228.851
AL$176.051
AR$173.561
AZ$190.601
CA$206.45–$258.0029
CO$203.521
CT$208.571
DC$223.341
DE$193.721
FL$193.18–$211.453
GA$182.51–$199.382
GU$211.311
HI$211.311
IA$180.291
ID$181.471
IL$187.81–$205.434
IN$182.491
KS$179.531
KY$180.261
LA$180.01–$188.722
MA$202.37–$223.292
MD$197.34–$223.343
ME$182.46–$192.062
MI$184.91–$195.612
MN$194.921
MO$177.03–$189.303
MS$175.321
MT$195.721
NC$184.321
ND$191.761
NE$181.241
NH$200.401
NJ$210.92–$221.122
NM$185.931
NV$194.751
NY$187.03–$230.345
OH$184.101
OK$179.871
OR$193.21–$209.802
PA$184.35–$203.512
PR$197.111
RI$200.481
SC$184.521
SD$191.291
TN$180.421
TX$183.17–$202.878
UT$186.991
VA$191.48–$223.342
VI$197.111
VT$191.091
WA$201.96–$227.732
WI$185.471
WV$181.021
WY$193.991

Explore 28495 on the national rate map →

Where does this rate apply?

Delaware is a Medicare payment area. Our Census mapping connects it to 79 cities and communities in Delaware, 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.

Browse all communities in Delaware →

Why are the office and facility amounts different?

For 28495 in Delaware, the physician’s office rate is $193.72 and the facility-setting rate is $152.80: a difference of $40.92.

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 28495 in Delaware. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$213.09

$193.72 × 110% = $213.09

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.

Compare your contract offer →

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 28495 in Delaware.

PPRRVU2026_Oct_nonQPP.csv

3,217

Code
28495
Physician work
1.64
Practice expense
4.02
Malpractice
0.20

GPCI2026.csv

40

Locality
Delaware
Physician work
1.005
Practice expense
0.988
Malpractice
0.899
Office / nonfacility calculation for 28495 in Delaware
ComponentRVULocality factorAdjusted
Physician work1.64× 1.0051.6482
Practice expense4.02× 0.9883.9718
Malpractice0.20× 0.8990.1798
Total RVUs5.7998
Conversion factor× 33.4009

Office / nonfacility rate, Delaware$193.72

Open 28495 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work1.641.005
Practice expense4.020.988
Malpractice0.20.899

(1.64 × 1.005 + 4.02 × 0.988 + 0.2 × 0.899) × $33.4009 = $193.72

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work1.641.005
Practice expense2.780.988
Malpractice0.20.899

(1.64 × 1.005 + 2.78 × 0.988 + 0.2 × 0.899) × $33.4009 = $152.80

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

28495 · Office / nonfacility

$193.72

Effective 2026-10-01

The base rate is $12.07 higher than on 2025-10-01, moving from $181.65 to $193.72 (6.6%).

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

    $181.65changed to$193.72

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.68 changed to 1.64
    • Practice expense RVU 3.78 changed to 4.02
    • Malpractice RVU 0.18 changed to 0.20
    • Work GPCI 1.009 changed to 1.005
    • Practice expense GPCI 0.992 changed to 0.988
    • Malpractice GPCI 0.949 changed to 0.899

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $181.65

    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$193.72$152.80RVU26D
2026-07-01$193.72$152.80RVU26C
2026-04-01$193.72$152.80RVU26B
2026-01-01$193.72$152.80RVU26A
2025-10-01$181.65$151.49RVU25D
2025-07-01$181.65$151.49RVU25C
2025-04-01$181.65$151.49RVU25B
2025-01-01$181.65$151.49RVU25A

28495 billing questions

How does 28495 differ from 28490?

28495 is for closed treatment of a great-toe phalanx fracture with manipulation. Use 28490 when the fracture is treated without manipulation.

When is 28496 used instead?

28496 describes percutaneous skeletal fixation of a great-toe phalanx fracture with manipulation. 28495 is the closed-treatment code when percutaneous fixation is not performed.

Are routine related postoperative visits separately reported?

The 90-day global period includes related postoperative care, as well as the day-before preoperative visit.

Can modifier 50 be used when both great toes are treated?

CMS identifies this as a bilateral procedure; bilateral reporting with modifier 50 is paid at 150%.

Can an assistant surgeon or co-surgeon be reported?

CMS does not pay an assistant at surgery for 28495. Co-surgeons and team surgery are not permitted.

Does this code include fractures of the lesser toes?

No. This code is specific to a great-toe phalanx fracture; lesser-toe fractures are reported with codes for other toes.

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 28495PPRRVU2026_Oct_nonQPP.csv, line 3,217 (RVU26D)
Geographic factors for DelawareGPCI2026.csv, line 40 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet