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CMS RVU26D · Effective 2026-10-01

28531 in Modesto

Office / nonfacility

$343.81

Base rate per service

Facility setting

$180.91

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 28531: Open treatment of sesamoid fracture

Open surgical treatment of a fractured foot sesamoid, typically beneath the first metatarsal head, when care requires direct operative exposure.

Code 28531 represents operative treatment of a fractured sesamoid, a small bone beneath the first metatarsal head at the great-toe joint. An orthopedic foot-and-ankle surgeon or podiatric surgeon typically exposes the fracture directly and treats it surgically; internal fixation may be used when indicated. This is distinct from treating a fracture of the great-toe phalanx or a metatarsal.

Report this code for open fracture treatment rather than closed management under 28530. The operative note should identify the sesamoid fracture and describe the open treatment performed. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. In a same-session multiple-procedure case, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; co-surgeons are permitted, while team surgery is not.

CMS billing rules for 28531

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 permitted.
Team surgery
Team surgery not permitted.

Where the value comes from

  • Work RVU2.51 · 26%
  • Practice expense (office) RVU6.96 · 72%
  • Malpractice RVU0.21 · 2%

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.

28531 compared with similar codes

Office rates for Modesto, from the same CMS release.

28530

Sesamoid fracture care

Without manipulation

$130.35

Choose 28530 for closed treatment of a sesamoid fracture. Choose 28531 when the fracture is treated through open operative exposure.

28505

Toe fracture surgery

Great toe, open treatment

$695.61

This code concerns open treatment of a great-toe fracture; 28531 is for a sesamoid fracture beneath the great-toe joint.

28315

Sesamoidectomy

Foot sesamoid bone

$504.54

This code describes sesamoid excision. Code 28531 describes open treatment of a sesamoid fracture, rather than removal of the bone.

The same code, a different location

How does Modesto compare?

In Bakersfield, the office rate for 28531 is $344.49—$0.68 higher than the $343.81 rate in Modesto. Both use the same code, release and participation basis.

28531 across payment areas

Same release and payment basis · bars start at $0

  1. Modesto · This locality

    $343.81

  2. Bakersfield

    $344.49

    $0.68 higher than Modesto

  3. Chico

    $343.81

    The same base rate than Modesto

  4. El Centro

    $343.84

    $0.03 higher than Modesto

  5. Fresno

    $343.81

    The same base rate than Modesto

  6. Hanford-Corcoran

    $343.81

    The same base rate than Modesto

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

    $366.94

    $23.13 higher than Modesto

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, 28531 ranges from $287.14 in Arkansas to $432.04 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

  • Madera

    California · 28531

    Office

    $343.81

    Facility

    $180.91

    The same base rate than Modesto for the office setting.

  • Merced

    California · 28531

    Office

    $343.81

    Facility

    $180.91

    The same base rate than Modesto for the office setting.

  • Napa

    California · 28531

    Office

    $399.08

    Facility

    $203.18

    $55.27 higher than Modesto for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 28531

    Office

    $365.33

    Facility

    $189.65

    $21.52 higher than Modesto for the office setting.

  • Redding

    California · 28531

    Office

    $343.81

    Facility

    $180.91

    The same base rate than Modesto for the office setting.

  • Rest Of California

    California · 28531

    Office

    $343.81

    Facility

    $180.91

    The same base rate than Modesto for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 28531

    Office

    $346.12

    Facility

    $183.21

    $2.31 higher than Modesto for the office setting.

  • Sacramento-Roseville-Folsom

    California · 28531

    Office

    $360.98

    Facility

    $188.12

    $17.17 higher than Modesto for the office setting.

  • Salinas

    California · 28531

    Office

    $359.63

    Facility

    $187.36

    $15.82 higher than Modesto for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 28531

    Office

    $368.19

    Facility

    $190.42

    $24.38 higher than Modesto for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 28531

    Office

    $422.80

    Facility

    $213.23

    $78.99 higher than Modesto for the office setting.

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

    California · 28531

    Office

    $422.56

    Facility

    $212.99

    $78.75 higher than Modesto for the office setting.

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

    California · 28531

    Office

    $432.04

    Facility

    $217.71

    $88.23 higher than Modesto for the office setting.

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

    California · 28531

    Office

    $431.07

    Facility

    $216.73

    $87.26 higher than Modesto for the office setting.

  • San Luis Obispo-Paso Robles

    California · 28531

    Office

    $353.80

    Facility

    $184.51

    $9.99 higher than Modesto for the office setting.

  • Santa Cruz-Watsonville

    California · 28531

    Office

    $371.81

    Facility

    $191.22

    $28.00 higher than Modesto for the office setting.

  • Santa Maria-Santa Barbara

    California · 28531

    Office

    $361.00

    Facility

    $187.70

    $17.19 higher than Modesto for the office setting.

  • Santa Rosa-Petaluma

    California · 28531

    Office

    $375.58

    Facility

    $193.06

    $31.77 higher than Modesto for the office setting.

  • Stockton

    California · 28531

    Office

    $343.81

    Facility

    $180.91

    The same base rate than Modesto for the office setting.

  • Vallejo

    California · 28531

    Office

    $398.73

    Facility

    $202.83

    $54.92 higher than Modesto for the office setting.

  • Visalia

    California · 28531

    Office

    $343.81

    Facility

    $180.91

    The same base rate than Modesto for the office setting.

  • Yuba City

    California · 28531

    Office

    $343.81

    Facility

    $180.91

    The same base rate than Modesto for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 28531

    Office

    $370.02

    Facility

    $194.93

    $26.21 higher than Modesto for the office setting.

  • Miami

    Florida · 28531

    Office

    $343.58

    Facility

    $188.85

    $0.23 lower than Modesto for the office setting.

  • Chicago

    Illinois · 28531

    Office

    $334.15

    Facility

    $184.78

    $9.66 lower than Modesto for the office setting.

  • Manhattan

    New York · 28531

    Office

    $370.46

    Facility

    $197.74

    $26.65 higher than Modesto for the office setting.

  • Alaska*

    Alaska · 28531

    Office

    $377.20

    Facility

    $218.90

    $33.39 higher than Modesto for the office setting.

  • Alabama

    Alabama · 28531

    Office

    $291.22

    Facility

    $161.16

    $52.59 lower than Modesto for the office setting.

  • Arkansas

    Arkansas · 28531

    Office

    $287.14

    Facility

    $159.46

    $56.67 lower than Modesto for the office setting.

  • Arizona

    Arizona · 28531

    Office

    $315.10

    Facility

    $171.08

    $28.71 lower than Modesto for the office setting.

  • Colorado

    Colorado · 28531

    Office

    $337.67

    Facility

    $179.52

    $6.14 lower than Modesto for the office setting.

  • Connecticut

    Connecticut · 28531

    Office

    $344.37

    Facility

    $184.29

    $0.56 higher than Modesto for the office setting.

  • Delaware

    Delaware · 28531

    Office

    $320.24

    Facility

    $173.39

    $23.57 lower than Modesto for the office setting.

  • Fort Lauderdale

    Florida · 28531

    Office

    $332.01

    Facility

    $181.44

    $11.80 lower than Modesto for the office setting.

  • Rest Of Florida

    Florida · 28531

    Office

    $316.62

    Facility

    $174.53

    $27.19 lower than Modesto for the office setting.

  • Atlanta

    Georgia · 28531

    Office

    $328.70

    Facility

    $177.69

    $15.11 lower than Modesto for the office setting.

  • Rest Of Georgia

    Georgia · 28531

    Office

    $299.56

    Facility

    $166.98

    $44.25 lower than Modesto for the office setting.

  • Hawaii, Guam

    Hawaii · 28531

    Office

    $352.22

    Facility

    $183.22

    $8.41 higher than Modesto for the office setting.

  • Iowa

    Iowa · 28531

    Office

    $299.33

    Facility

    $163.33

    $44.48 lower than Modesto for the office setting.

  • Idaho

    Idaho · 28531

    Office

    $301.03

    Facility

    $164.28

    $42.78 lower than Modesto for the office setting.

  • East St. Louis

    Illinois · 28531

    Office

    $311.84

    Facility

    $175.09

    $31.97 lower than Modesto for the office setting.

  • Rest Of Illinois

    Illinois · 28531

    Office

    $307.04

    Facility

    $171.34

    $36.77 lower than Modesto for the office setting.

  • Suburban Chicago

    Illinois · 28531

    Office

    $335.60

    Facility

    $182.95

    $8.21 lower than Modesto for the office setting.

  • Indiana

    Indiana · 28531

    Office

    $302.75

    Facility

    $164.96

    $41.06 lower than Modesto for the office setting.

  • Kansas

    Kansas · 28531

    Office

    $297.52

    Facility

    $163.16

    $46.29 lower than Modesto for the office setting.

  • Kentucky

    Kentucky · 28531

    Office

    $296.92

    Facility

    $164.78

    $46.89 lower than Modesto for the office setting.

  • New Orleans

    Louisiana · 28531

    Office

    $310.56

    Facility

    $170.69

    $33.25 lower than Modesto for the office setting.

  • Rest Of Louisiana

    Louisiana · 28531

    Office

    $296.29

    Facility

    $164.75

    $47.52 lower than Modesto for the office setting.

  • Metropolitan Boston

    Massachusetts · 28531

    Office

    $371.09

    Facility

    $193.62

    $27.28 higher than Modesto for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 28531

    Office

    $335.56

    Facility

    $179.05

    $8.25 lower than Modesto for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 28531

    Office

    $343.29

    Facility

    $183.81

    $0.52 lower than Modesto for the office setting.

  • Rest Of Maryland

    Maryland · 28531

    Office

    $326.37

    Facility

    $175.96

    $17.44 lower than Modesto for the office setting.

  • Rest Of Maine

    Maine · 28531

    Office

    $302.07

    Facility

    $165.33

    $41.74 lower than Modesto for the office setting.

  • Southern Maine

    Maine · 28531

    Office

    $318.64

    Facility

    $171.34

    $25.17 lower than Modesto for the office setting.

  • Detroit

    Michigan · 28531

    Office

    $320.00

    Facility

    $176.56

    $23.81 lower than Modesto for the office setting.

  • Rest Of Michigan

    Michigan · 28531

    Office

    $304.00

    Facility

    $168.30

    $39.81 lower than Modesto for the office setting.

  • Minnesota

    Minnesota · 28531

    Office

    $325.12

    Facility

    $172.18

    $18.69 lower than Modesto for the office setting.

  • Metropolitan Kansas City

    Missouri · 28531

    Office

    $308.98

    Facility

    $169.41

    $34.83 lower than Modesto for the office setting.

  • Metropolitan St. Louis

    Missouri · 28531

    Office

    $312.18

    Facility

    $170.68

    $31.63 lower than Modesto for the office setting.

  • Rest Of Missouri

    Missouri · 28531

    Office

    $291.06

    Facility

    $162.93

    $52.75 lower than Modesto for the office setting.

  • Mississippi

    Mississippi · 28531

    Office

    $289.18

    Facility

    $161.20

    $54.63 lower than Modesto for the office setting.

  • Montana**

    Montana · 28531

    Office

    $323.31

    Facility

    $174.67

    $20.50 lower than Modesto for the office setting.

  • North Carolina

    North Carolina · 28531

    Office

    $305.21

    Facility

    $166.54

    $38.60 lower than Modesto for the office setting.

  • North Dakota**

    North Dakota · 28531

    Office

    $319.15

    Facility

    $170.52

    $24.66 lower than Modesto for the office setting.

  • Nebraska

    Nebraska · 28531

    Office

    $301.06

    Facility

    $163.87

    $42.75 lower than Modesto for the office setting.

  • New Hampshire

    New Hampshire · 28531

    Office

    $331.98

    Facility

    $177.25

    $11.83 lower than Modesto for the office setting.

  • Northern Nj

    New Jersey · 28531

    Office

    $366.27

    Facility

    $193.86

    $22.46 higher than Modesto for the office setting.

  • Rest Of New Jersey

    New Jersey · 28531

    Office

    $348.74

    Facility

    $186.43

    $4.93 higher than Modesto for the office setting.

  • New Mexico

    New Mexico · 28531

    Office

    $305.44

    Facility

    $169.14

    $38.37 lower than Modesto for the office setting.

  • Nevada**

    Nevada · 28531

    Office

    $322.38

    Facility

    $173.60

    $21.43 lower than Modesto for the office setting.

  • Nyc Suburbs/Long Island

    New York · 28531

    Office

    $378.63

    Facility

    $201.91

    $34.82 higher than Modesto for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 28531

    Office

    $350.65

    Facility

    $187.90

    $6.84 higher than Modesto for the office setting.

  • Queens

    New York · 28531

    Office

    $374.10

    Facility

    $198.41

    $30.29 higher than Modesto for the office setting.

  • Rest Of New York

    New York · 28531

    Office

    $309.61

    Facility

    $168.41

    $34.20 lower than Modesto for the office setting.

  • Ohio

    Ohio · 28531

    Office

    $303.15

    Facility

    $167.45

    $40.66 lower than Modesto for the office setting.

  • Oklahoma

    Oklahoma · 28531

    Office

    $296.88

    Facility

    $164.15

    $46.93 lower than Modesto for the office setting.

  • Portland

    Oregon · 28531

    Office

    $348.67

    Facility

    $183.54

    $4.86 higher than Modesto for the office setting.

  • Rest Of Oregon

    Oregon · 28531

    Office

    $320.31

    Facility

    $172.27

    $23.50 lower than Modesto for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 28531

    Office

    $335.71

    Facility

    $180.99

    $8.10 lower than Modesto for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 28531

    Office

    $303.87

    Facility

    $167.43

    $39.94 lower than Modesto for the office setting.

  • Puerto Rico

    Puerto Rico · 28531

    Office

    $325.77

    Facility

    $175.50

    $18.04 lower than Modesto for the office setting.

  • Rhode Island

    Rhode Island · 28531

    Office

    $331.83

    Facility

    $178.29

    $11.98 lower than Modesto for the office setting.

  • South Carolina

    South Carolina · 28531

    Office

    $304.60

    Facility

    $167.26

    $39.21 lower than Modesto for the office setting.

  • South Dakota**

    South Dakota · 28531

    Office

    $318.66

    Facility

    $170.03

    $25.15 lower than Modesto for the office setting.

  • Tennessee

    Tennessee · 28531

    Office

    $298.92

    Facility

    $163.81

    $44.89 lower than Modesto for the office setting.

  • Austin

    Texas · 28531

    Office

    $336.17

    Facility

    $178.92

    $7.64 lower than Modesto for the office setting.

  • Beaumont

    Texas · 28531

    Office

    $301.90

    Facility

    $166.64

    $41.91 lower than Modesto for the office setting.

  • Brazoria

    Texas · 28531

    Office

    $320.36

    Facility

    $173.06

    $23.45 lower than Modesto for the office setting.

  • Dallas

    Texas · 28531

    Office

    $322.15

    Facility

    $174.11

    $21.66 lower than Modesto for the office setting.

  • Fort Worth

    Texas · 28531

    Office

    $319.92

    Facility

    $173.36

    $23.89 lower than Modesto for the office setting.

  • Galveston

    Texas · 28531

    Office

    $321.16

    Facility

    $173.56

    $22.65 lower than Modesto for the office setting.

  • Houston

    Texas · 28531

    Office

    $325.00

    Facility

    $177.41

    $18.81 lower than Modesto for the office setting.

  • Rest Of Texas

    Texas · 28531

    Office

    $310.78

    Facility

    $169.73

    $33.03 lower than Modesto for the office setting.

  • Utah

    Utah · 28531

    Office

    $308.66

    Facility

    $168.94

    $35.15 lower than Modesto for the office setting.

  • Virginia

    Virginia · 28531

    Office

    $317.31

    Facility

    $171.20

    $26.50 lower than Modesto for the office setting.

  • Virgin Islands

    United States Virgin Islands · 28531

    Office

    $325.77

    Facility

    $175.50

    $18.04 lower than Modesto for the office setting.

  • Vermont

    Vermont · 28531

    Office

    $317.53

    Facility

    $170.38

    $26.28 lower than Modesto for the office setting.

  • Rest Of Washington

    Washington · 28531

    Office

    $335.06

    Facility

    $178.54

    $8.75 lower than Modesto for the office setting.

  • Seattle (King Cnty)

    Washington · 28531

    Office

    $379.00

    Facility

    $196.63

    $35.19 higher than Modesto for the office setting.

  • Wisconsin

    Wisconsin · 28531

    Office

    $308.70

    Facility

    $166.31

    $35.11 lower than Modesto for the office setting.

  • West Virginia

    West Virginia · 28531

    Office

    $295.89

    Facility

    $166.73

    $47.92 lower than Modesto for the office setting.

  • Wyoming**

    Wyoming · 28531

    Office

    $321.50

    Facility

    $172.86

    $22.31 lower than Modesto for the office setting.

See how rates vary across the country

28531 · 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.

$287.14

$387.93

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

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$377.201
AL$291.221
AR$287.141
AZ$315.101
CA$343.81–$432.0429
CO$337.671
CT$344.371
DC$370.021
DE$320.241
FL$316.62–$343.583
GA$299.56–$328.702
GU$352.221
HI$352.221
IA$299.331
ID$301.031
IL$307.04–$335.604
IN$302.751
KS$297.521
KY$296.921
LA$296.29–$310.562
MA$335.56–$371.092
MD$326.37–$370.023
ME$302.07–$318.642
MI$304.00–$320.002
MN$325.121
MO$291.06–$312.183
MS$289.181
MT$323.311
NC$305.211
ND$319.151
NE$301.061
NH$331.981
NJ$348.74–$366.272
NM$305.441
NV$322.381
NY$309.61–$378.635
OH$303.151
OK$296.881
OR$320.31–$348.672
PA$303.87–$335.712
PR$325.771
RI$331.831
SC$304.601
SD$318.661
TN$298.921
TX$301.90–$336.178
UT$308.661
VA$317.31–$370.022
VI$325.771
VT$317.531
WA$335.06–$379.002
WI$308.701
WV$295.891
WY$321.501

Explore 28531 on the national rate map →

Where does this rate apply?

Modesto is a Medicare payment area. Our Census mapping connects it to 33 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.

Browse all communities in California →

Why are the office and facility amounts different?

For 28531 in Modesto, the physician’s office rate is $343.81 and the facility-setting rate is $180.91: a difference of $162.90.

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 28531 in Modesto. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$378.19

$343.81 × 110% = $378.19

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 28531 in Modesto.

PPRRVU2026_Oct_nonQPP.csv

3,224

Code
28531
Physician work
2.51
Practice expense
6.96
Malpractice
0.21

GPCI2026.csv

16

Locality
Modesto
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Office / nonfacility calculation for 28531 in Modesto
ComponentRVULocality factorAdjusted
Physician work2.51× 1.0172.5527
Practice expense6.96× 1.0967.6282
Malpractice0.21× 0.5360.1126
Total RVUs10.2934
Conversion factor× 33.4009

Office / nonfacility rate, Modesto$343.81

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

Open 28531 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work2.511.017
Practice expense6.961.096
Malpractice0.210.536

(2.51 × 1.017 + 6.96 × 1.096 + 0.21 × 0.536) × $33.4009 = $343.81

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work2.511.017
Practice expense2.511.096
Malpractice0.210.536

(2.51 × 1.017 + 2.51 × 1.096 + 0.21 × 0.536) × $33.4009 = $180.91

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

28531 · Office / nonfacility

$343.81

Effective 2026-10-01

The base rate is $5.05 higher than on 2025-10-01, moving from $338.76 to $343.81 (1.5%).

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

    $338.76changed to$343.81

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.57 changed to 2.51
    • Practice expense RVU 7.09 changed to 6.96
    • 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: $338.76

    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$343.81$180.91RVU26D
2026-07-01$343.81$180.91RVU26C
2026-04-01$343.81$180.91RVU26B
2026-01-01$343.81$180.91RVU26A
2025-10-01$338.76$187.09RVU25D
2025-07-01$338.76$187.09RVU25C
2025-04-01$338.76$187.09RVU25B
2025-01-01$338.76$187.09RVU25A

28531 billing questions

When should 28531 be chosen over 28530?

Use 28531 for open operative treatment of the sesamoid fracture. Code 28530 describes closed treatment.

Does 28531 include internal fixation?

Yes. Internal fixation is included when performed as part of the open treatment.

What global period applies?

CMS assigns a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care.

How is bilateral treatment paid?

When both sides are treated and modifier 50 is reported, CMS pays 150%.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment is barred by the statutory restriction. Co-surgeons are permitted; team surgery is not.

How does the multiple-procedure rule affect payment?

For procedures performed in the same session, the highest-valued procedure is paid in full and 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 28531PPRRVU2026_Oct_nonQPP.csv, line 3,224 (RVU26D)
Geographic factors for ModestoGPCI2026.csv, line 16 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet