Billing code 28291: Hallux rigidus surgeryMedicare rate & RVUs in Florida
Corrects painful, stiff first metatarsophalangeal joint arthritis with joint debridement and an implant when motion-preserving surgery is selected.
Medicare pays $665.49–$722.93 for 28291 in the office in Florida, from Rest Of Florida to Miami. 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 28291 covers
A foot and ankle surgeon or podiatric surgeon uses this code for implant arthroplasty to treat symptomatic hallux rigidus at the first metatarsophalangeal joint. The procedure addresses degenerative joint changes and restricted, painful great-toe motion through joint debridement, removal of obstructive bone, capsular release, and implant placement. It is typically performed in an outpatient surgical setting when the operative plan includes an implant rather than correction without one.
Report 28291 for the documented implant procedure, not simply because imaging shows arthritis or an implant was considered. The operative report should support the hallux rigidus diagnosis, the work performed at the joint, and implant placement. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of 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 may be made; co-surgeon payment requires supporting documentation, and team surgery is 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.
Where 28291 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$665.49 to $722.93
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | $694.80 | $464.38 |
| Miami | $722.93 | $486.14 |
| Rest Of Florida | $665.49 | $448.04 |
How the 28291 rate is calculated
Each of 28291’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 · 28291
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 7.81Practice expense 11.54Malpractice 0.72
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 28291
28291 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 28291
Hallux rigidus surgery
| 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) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| 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 · 28291
Hallux rigidus surgery
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
28291 without 50 · national office
$670.36
Hallux rigidus surgery
28291-50 · Bilateral: 150%
$1,005.54
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).
28291 compared with similar codes
Compare codes
28291 vs 28289 vs 28292 vs 28295: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 28289Hallux rigidus surgery
- Both address hallux rigidus with joint debridement and release; 28291 includes implant placement, while 28289 is the choice without an implant.
- 28292Bunion correction
- This corrects hallux valgus, or bunion alignment, rather than implant-treated degenerative stiffness of the first metatarsophalangeal joint.
- 28295Bunion correction
- This is a hallux valgus correction involving a proximal first-metatarsal osteotomy; 28291 treats hallux rigidus with an implant.
28291 billing questions
When should 28291 be chosen instead of 28289?
Use 28291 when the hallux rigidus correction includes implant placement. Code 28289 describes the corresponding correction without an implant.
Does the code include the joint debridement and capsular release?
Yes. These are part of the described hallux rigidus correction; do not separately report them as though they were unrelated procedures.
What operative documentation supports 28291?
Document the symptomatic first metatarsophalangeal joint condition, the correction performed, and placement of the implant. The operative note should make clear that the procedure was an implant correction rather than correction without an implant.
How is modifier 50 handled for bilateral surgery?
CMS pays bilateral reporting with modifier 50 at 150%. The record should support that the same procedure was performed on both sides.
How does CMS handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures are paid at 50%. Related postoperative care is included in the 90-day global period.
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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