Billing code 28496: Great toe fractureMedicare rate & RVUs in Guam
Percutaneous skeletal fixation with manipulation treats a great toe fracture when the fracture requires reduction and pin fixation rather than closed treatment alone.
Medicare pays $603.19 for 28496 in the office in Guam (Hawaii, Guam). 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 28496 covers
An orthopedic surgeon or podiatric surgeon uses manipulation to reduce a great toe fracture and places skeletal fixation through the skin, typically with pins, to stabilize the fracture. This approach is used when the fracture needs fixation but is treated percutaneously rather than through open exposure. The service is generally performed in a surgical facility; the 2024 Medicare file reports facility services for this code.
Choose this code when the documented treatment includes both manipulation and percutaneous skeletal fixation of a great toe fracture. The operative report should identify the great toe fracture, reduction, and percutaneous fixation performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For same-session procedures, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; 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.
28496 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | $603.19 | $298.99 |
How the 28496 rate is calculated
Each of 28496’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 · 28496
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.42Practice expense 13.50Malpractice 0.50
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 28496
28496 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 28496
Great toe fracture
| 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 · 28496
Great toe fracture
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
28496 without 50 · national office
$548.44
Great toe fracture
28496-50 · Bilateral: 150%
$822.66
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).
28496 compared with similar codes
Compare codes
28496 vs 28490 vs 28495 vs 28505: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 28490Toe fracture care
- Use 28490 for closed treatment of a great toe fracture without manipulation. Use 28496 when manipulation and percutaneous skeletal fixation are performed.
- 28495Toe fracture treatment
- Use 28495 for closed treatment with manipulation but without skeletal fixation. Use 28496 when percutaneous fixation is added to the treatment.
- 28505Toe fracture surgery
- 28505 describes open treatment of a great toe phalangeal fracture. Choose 28496 when the fracture is reduced and fixed percutaneously rather than treated through open exposure.
28496 billing questions
How does this differ from 28495?
28495 describes closed treatment with manipulation. Use 28496 when the great toe fracture is also treated with percutaneous skeletal fixation.
How does this differ from 28490?
28490 is closed treatment without manipulation. This code represents manipulation plus percutaneous skeletal fixation.
Can the fixation be reported separately from the fracture treatment?
Percutaneous skeletal fixation is part of the service represented by 28496. Do not report a separate fracture-treatment code for the same great toe fracture.
What should the operative note document?
Document the great toe fracture, manipulation or reduction, and the percutaneous skeletal fixation performed. The record should support that the treatment went beyond closed reduction alone.
How is bilateral treatment reported?
When both great toes are treated, report bilateral services with modifier 50. CMS pays bilateral reporting at 150%.
Does the code include related postoperative visits?
Yes. Its 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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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