$339.56
Choose 28645 for open treatment of the metatarsophalangeal joint. Choose 28636 when the dislocation is treated closed with percutaneous skeletal fixation.
On this page
CMS RVU26D · Effective 2026-10-01
28645 Toe dislocation repair Medicare reimbursement rates in Arkansas
Reports open surgical reduction and repair of a dislocated toe metatarsophalangeal joint, including internal fixation when performed. Compare 28645 office and facility rates across CMS payment localities in Arkansas.
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.
What does Medicare pay for 28645 in Arkansas?
Arkansas has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$596.20
1 of 1 localities have a supported rate.
Payment area: Arkansas
One mapped payment locality.
Facility setting
$420.03
1 of 1 localities have a supported rate.
Payment area: Arkansas
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Orthopedic surgery
About 28645: Open repair of toe metatarsophalangeal dislocation
Reports open surgical reduction and repair of a dislocated toe metatarsophalangeal joint, including internal fixation when performed.
This service treats a dislocation of a toe’s metatarsophalangeal joint through an open surgical approach. The surgeon exposes the joint, restores alignment, and addresses the dislocation; internal fixation may be used when needed. Orthopedic surgeons and podiatric surgeons commonly perform the procedure in an operating room, often when the joint requires open treatment rather than closed reduction.
Report the code for open treatment of a metatarsophalangeal dislocation, not for closed reduction or for an open dislocation of an interphalangeal joint. The operative note should identify the affected toe and joint, describe the open approach and treatment, and document any fixation. Medicare 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 the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment is restricted; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 28645
- 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 adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU7.25 · 36%
- Practice expense (office) RVU11.80 · 59%
- Malpractice RVU0.90 · 5%
1.9K
Medicare services in 2024 · #2490 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.
28645 compared with similar codes
Office rates for Arkansas, from the same CMS release.
$156.52
Code 28635 describes closed treatment of a metatarsophalangeal dislocation with anesthesia; 28645 is for open surgical treatment.
$522.73
Both involve open treatment, but 28675 is for an interphalangeal joint dislocation. Code 28645 is for a metatarsophalangeal joint dislocation.
Compare 28645 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Arkansas →
Office / nonfacility
$596.20
Facility
$420.03
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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 28645 in Arkansas.
PPRRVU2026_Oct_nonQPP.csv
3,240
- Code
- 28645
- Physician work
- 7.25
- Practice expense
- 11.80
- Malpractice
- 0.90
GPCI2026.csv
7
- Locality
- Arkansas
- Physician work
- 1.000
- Practice expense
- 0.859
- Malpractice
- 0.515
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.25 | × 1.000 | 7.2500 |
| Practice expense | 11.80 | × 0.859 | 10.1362 |
| Malpractice | 0.90 | × 0.515 | 0.4635 |
| Total RVUs | 17.8497 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Arkansas$596.20
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.25 | 1 |
| Practice expense | 11.8 | 0.859 |
| Malpractice | 0.9 | 0.515 |
(7.25 × 1 + 11.8 × 0.859 + 0.9 × 0.515) × $33.4009 = $596.20
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.25 | 1 |
| Practice expense | 5.66 | 0.859 |
| Malpractice | 0.9 | 0.515 |
(7.25 × 1 + 5.66 × 0.859 + 0.9 × 0.515) × $33.4009 = $420.03
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.
28645 billing questions
When should I report 28645 instead of 28636?
Use 28645 for open treatment of a metatarsophalangeal joint dislocation. Code 28636 describes closed treatment with percutaneous skeletal fixation.
How does 28645 differ from 28675?
The joint determines the choice: 28645 is for an open metatarsophalangeal dislocation, while 28675 is for an open interphalangeal dislocation.
What documentation supports reporting 28645?
Document the affected toe and metatarsophalangeal joint, the dislocation, the open surgical treatment, and any fixation performed.
Can modifier 50 be reported for bilateral toe treatment?
No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 should not be used.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are multiple procedures handled in the same session?
The highest-valued procedure is paid in full, and other procedures are paid at 50%. Assistant-at-surgery payment is restricted; co-surgeon payment requires supporting documentation.
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.
3,23728630,,Treat toe dislocation,A,,1.71,3.14,,1.32,,0.29,5.14,3.32,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,23828635,,Treat toe dislocation,A,,1.91,3.10,,1.55,,0.22,5.23,3.68,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,23928636,,Treat toe dislocation,A,,2.70,8.35,,3.24,,0.57,11.62,6.51,0,010,0.10,0.80,0.10,2,0,1,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,24028645,,Repair toe dislocation,A,,7.25,11.80,,5.66,,0.90,19.95,13.81,0,090,0.10,0.69,0.21,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,24128660,,Treat toe dislocation,A,,1.25,2.97,,1.52,,0.25,4.47,3.02,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,24228665,,Treat toe dislocation,A,,1.92,2.53,,1.48,,0.19,4.64,3.59,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,24328666,,Treat toe dislocation,A,,2.59,2.11,NA,2.11,,0.21,4.91,4.91,0,010,0.10,0.80,0.10,2,0,1,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515
801112,CA,54,BAKERSFIELD,1.019,1.096,0.609
901112,CA,55,CHICO,1.017,1.096,0.536
1001182,CA,71,EL CENTRO,1.017,1.096,0.541