$403.60
Choose 28050 for the other specified foot-joint site. This code is for a metatarsophalangeal joint; confirm the site in the operative report.
On this page
CMS RVU26D · Effective 2026-10-01
28052 Joint biopsy Medicare reimbursement rates in Delaware
Report this service when a surgeon opens a metatarsophalangeal joint to obtain synovial tissue for diagnostic evaluation. Compare 28052 office and facility rates across CMS payment localities in Delaware.
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 28052 in Delaware?
Delaware 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
$377.74
1 of 1 localities have a supported rate.
Payment area: Delaware
One mapped payment locality.
Facility setting
$240.79
1 of 1 localities have a supported rate.
Payment area: Delaware
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.
Foot surgery
About 28052: Open metatarsophalangeal joint lining biopsy
Report this service when a surgeon opens a metatarsophalangeal joint to obtain synovial tissue for diagnostic evaluation.
A foot and ankle surgeon, orthopedic surgeon, or podiatric surgeon opens a metatarsophalangeal joint and takes a sample of its synovial lining. The tissue may be sent for evaluation when the cause of joint inflammation or another abnormal process remains uncertain. This is an open joint procedure, not simply a needle sample or inspection of the joint. The code is specific to the metatarsophalangeal joint; the operative report should identify the joint and document the tissue sampled.
Report the service for the joint actually biopsied, supported by the operative note and specimen documentation. 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 other procedures are subject to the standard 50% reduction. For bilateral reporting with modifier 50, CMS pays at 150%. Medicare does not pay an assistant at surgery for this code. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 28052
- 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 paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU3.96 · 35%
- Practice expense (office) RVU7.10 · 62%
- Malpractice RVU0.35 · 3%
51
Medicare services in 2024 · #5342 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.
28052 compared with similar codes
Office rates for Delaware, from the same CMS release.
$354.54
Choose 28054 when the biopsied joint is an interphalangeal joint in a toe. This code is for a metatarsophalangeal joint.
$497.30
Code 28072 represents removal of metatarsophalangeal joint lining. This code describes diagnostic sampling rather than removal of the lining as treatment.
Compare 28052 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
Delaware →
Office / nonfacility
$377.74
Facility
$240.79
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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 28052 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
3,105
- Code
- 28052
- Physician work
- 3.96
- Practice expense
- 7.10
- Malpractice
- 0.35
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.96 | × 1.005 | 3.9798 |
| Practice expense | 7.10 | × 0.988 | 7.0148 |
| Malpractice | 0.35 | × 0.899 | 0.3146 |
| Total RVUs | 11.3092 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Delaware$377.74
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.96 | 1.005 |
| Practice expense | 7.1 | 0.988 |
| Malpractice | 0.35 | 0.899 |
(3.96 × 1.005 + 7.1 × 0.988 + 0.35 × 0.899) × $33.4009 = $377.74
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.96 | 1.005 |
| Practice expense | 2.95 | 0.988 |
| Malpractice | 0.35 | 0.899 |
(3.96 × 1.005 + 2.95 × 0.988 + 0.35 × 0.899) × $33.4009 = $240.79
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.
28052 billing questions
How is this code distinguished from 28050?
This code is for biopsy of a metatarsophalangeal joint lining. Code 28050 is for a different foot-joint site, so the operative report must identify the joint entered.
How is this code distinguished from 28054?
Use this code for a metatarsophalangeal joint biopsy and 28054 for an interphalangeal toe-joint biopsy. The documented joint site determines the choice.
Can the biopsy be reported separately from the joint procedure?
The joint exposure and synovial sampling are represented by this service; do not separately report another biopsy procedure for the same tissue collection.
What documentation supports reporting this code?
Document the metatarsophalangeal joint entered, the open approach, the synovial tissue obtained, and the reason for diagnostic sampling.
How does Medicare handle bilateral reporting and other procedures in the session?
CMS pays bilateral reporting with modifier 50 at 150%. For multiple procedures in one session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction.
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.
3,10228046,,Resect foot/toe tumor < 3 cm,A,,12.07,6.28,NA,6.28,,1.46,19.81,19.81,0,090,0.10,0.69,0.21,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,10328047,,Resect foot/toe tumor 3 cm/>,A,,17.01,8.94,NA,8.94,,2.71,28.66,28.66,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,10428050,,Biopsy of foot joint lining,A,,4.28,7.54,,3.23,,0.37,12.19,7.88,0,090,0.10,0.69,0.21,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,10528052,,Biopsy of foot joint lining,A,,3.96,7.10,,2.95,,0.35,11.41,7.26,0,090,0.10,0.69,0.21,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,10628054,,Biopsy of toe joint lining,A,,3.48,6.94,,2.89,,0.29,10.71,6.66,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,10728055,,Neurectomy foot,A,,6.13,4.31,NA,4.31,,0.69,11.13,11.13,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,10828060,,Partial removal foot fascia,A,,5.27,9.84,,4.41,,0.61,15.72,10.29,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503