Billing code 28505: Toe fracture surgeryMedicare rate & RVUs in Florida
Reports open surgical treatment of a great toe phalanx fracture, with internal fixation included when performed as part of the procedure.
Medicare pays $666.96–$733.04 for 28505 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 28505 covers
This code describes open treatment of a fracture in one or more phalanges of the great toe. The surgeon accesses the fracture site to reduce and treat the bone; internal fixation is included when performed. It applies to surgical treatment of the great toe, not to a fracture that is merely open through the skin. Orthopedic foot and ankle surgeons and podiatric surgeons commonly perform the service in an operating room or other surgical setting.
Report the code when the operative record supports open treatment of a great toe phalanx fracture. Documentation should identify the affected toe and fracture, describe the open treatment, and record fixation if used. The service has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, Medicare pays the highest-valued procedure in full and other procedures at 50%. When both sides are treated, modifier 50 is paid at 150%. Medicare does not pay an assistant at surgery; 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.
Where 28505 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
$666.96 to $733.04
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | $699.12 | $498.81 |
| Miami | $733.04 | $527.20 |
| Rest Of Florida | $666.96 | $477.92 |
How the 28505 rate is calculated
Each of 28505’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 · 28505
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 7.25Practice expense 11.81Malpractice 0.95
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 28505
28505 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 28505
Toe fracture 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) | 1 | Not paid (statutory restriction). |
| 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 · 28505
Toe fracture 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
28505 without 50 · national office
$668.35
Toe fracture surgery
28505-50 · Bilateral: 150%
$1,002.53
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).
28505 compared with similar codes
Compare codes
28505 vs 28490 vs 28495 vs 28525: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 28490Toe fracture care
- 28490 is for closed treatment of a great toe phalanx fracture without manipulation. Use 28505 when the fracture receives open surgical treatment.
- 28495Toe fracture treatment
- 28495 describes closed treatment of a great toe phalanx fracture with manipulation; 28505 describes open surgical treatment.
- 28525Toe fracture repair
- 28525 is open treatment for a phalanx fracture in a toe other than the great toe. Code 28505 is specific to the great toe.
28505 billing questions
Does open treatment mean the fracture had an open wound?
No. Here, open treatment refers to surgical access to the fracture; it does not by itself mean the fracture was open through the skin.
How does this differ from closed treatment with manipulation?
Use this code for open surgical treatment of a great toe phalanx fracture. Closed treatment with manipulation is represented by 28495.
Is internal fixation separately reported?
Internal fixation is included when performed as part of this fracture treatment; it is not separately reported as a separate service under this code.
What documentation supports the code?
The operative record should identify the great toe phalanx fracture and describe the open treatment performed, including any fixation used.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
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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