Billing code 28054: Joint biopsyMedicare rate & RVUs in Alaska
Reports surgical sampling of synovial lining from a toe joint when tissue is needed to investigate a joint condition.
Medicare pays $426.56 for 28054 in the office in Alaska (Alaska*). Which amount applies depends on the service address.
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 9 sections
What 28054 covers
A surgeon obtains a tissue sample from the synovial lining of a toe joint for diagnostic evaluation. This may be performed by a podiatric surgeon or an orthopedic foot and ankle surgeon in an operating room when a joint disorder requires tissue examination, such as suspected inflammatory or proliferative synovial disease. The specimen is submitted for examination; the service is sampling, not removal of the joint lining as treatment.
Report the code when the operative record identifies the toe joint sampled and documents that lining tissue was obtained for biopsy. It has a 90-day global period, including the day-before preoperative visit and 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 multiple procedure reduction. For bilateral reporting, modifier 50 is paid at 150%. Assistant-at-surgery payment requires documented medical necessity; 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.
28054 in Alaska*
| Payment locality | Office | Facility |
|---|---|---|
| Alaska* | $426.56 | $282.49 |
How the 28054 rate is calculated
Each of 28054’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 · 28054
RVUs × geographic indexes × conversion factor
Work3.48
3.48 RVUs× 1.000 GPCI
Practice expense6.94
6.94 RVUs× 1.000 GPCI
Malpractice0.29
0.29 RVUs× 1.000 GPCI
Adjusted RVUs
10.7100
Conversion factor
$33.4009
Medicare rate
$357.72
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 28054
28054 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 28054
Joint biopsy
| 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| 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 · 28054
Joint biopsy
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 50 · payment effect
With and without the modifier
28054 without 50 · national office
$357.72
Joint biopsy
28054-50 · Bilateral: 150%
$536.58
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
28054 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 28050Joint biopsy
- This code concerns a foot-joint lining biopsy; 28054 is for a toe-joint lining biopsy. Base selection on the joint sampled and the full code descriptor.
- 28052Joint biopsy
- Code 28052 is another foot-joint lining biopsy code. Code 28054 identifies biopsy of toe-joint lining.
- 28024Toe joint exploration
- Code 28024 describes exploration of a toe joint. Use 28054 when the operative service includes sampling the joint lining for diagnostic evaluation.
- 28072Joint synovectomy
- Code 28072 concerns removal of toe-joint lining, whereas 28054 represents biopsy sampling rather than therapeutic removal.
28054 billing questions
How is this different from a foot-joint lining biopsy?
This code is for tissue sampled from a toe joint. Codes 28050 and 28052 describe foot-joint lining biopsies; select according to the joint and the applicable full code descriptor.
When would a toe-joint exploration code be used instead?
Code 28024 describes exploration of a toe joint. Report 28054 when synovial lining tissue is sampled for diagnostic evaluation, rather than reporting exploration alone.
How does biopsy differ from removal of toe-joint lining?
A biopsy takes tissue for diagnosis. Code 28072 is associated with removal of toe-joint lining as a therapeutic procedure.
What documentation supports reporting this code?
The operative note should identify the toe joint, describe obtaining synovial lining tissue, and state the diagnostic reason for the sample.
How is bilateral performance reported?
CMS treats this as a bilateral procedure: modifier 50 is paid at 150% when the procedure is performed bilaterally.
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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