$172.00
Both codes treat great-toe phalanx fractures without open exposure. Choose 28495 when the provider manipulates the fracture; 28490 is for treatment without manipulation.
On this page
CMS RVU26D · Effective 2026-10-01
28495 Toe fracture treatment Medicare reimbursement rates in Hawaii
Closed reduction and treatment of a great-toe phalanx fracture when the provider manipulates the fracture without open exposure or percutaneous fixation. Compare 28495 office and facility rates across CMS payment localities in Hawaii.
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 28495 in Hawaii?
Hawaii 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
$211.31
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
Facility setting
$164.22
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
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.
Fracture treatment
About 28495: Great toe fracture closed reduction
Closed reduction and treatment of a great-toe phalanx fracture when the provider manipulates the fracture without open exposure or percutaneous fixation.
Code 28495 represents closed treatment of a fracture in a great-toe phalanx when the clinician manipulates the fracture to restore alignment. The provider may use manual reduction and then immobilize the toe, such as with taping, a rigid-soled shoe, or a splint. Typical cases include a displaced hallux phalanx fracture managed without an incision or percutaneous hardware. Orthopedic surgeons, podiatrists, and other clinicians qualified to manage fractures may perform this service in an office, emergency department, or facility setting.
Report the code for a great-toe phalanx fracture and document the fracture site and manipulation performed. CMS assigns a 90-day major-surgery global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. CMS does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.
CMS billing rules for 28495
- 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.64 · 28%
- Practice expense (office) RVU4.02 · 69%
- Malpractice RVU0.20 · 3%
238
Medicare services in 2024 · #4171 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.
28495 compared with similar codes
Office rates for Hawaii, from the same CMS release.
$603.19
28496 includes percutaneous skeletal fixation with manipulation. Use 28495 for closed treatment with manipulation when that fixation is not performed.
$293.01
28475 concerns a metatarsal fracture treated with manipulation, not a phalanx fracture of the great toe.
Compare 28495 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
Hawaii, Guam →
Office / nonfacility
$211.31
Facility
$164.22
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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 28495 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
3,217
- Code
- 28495
- Physician work
- 1.64
- Practice expense
- 4.02
- Malpractice
- 0.20
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.64 | × 1.000 | 1.6400 |
| Practice expense | 4.02 | × 1.137 | 4.5707 |
| Malpractice | 0.20 | × 0.579 | 0.1158 |
| Total RVUs | 6.3265 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Hawaii, Guam$211.31
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.64 | 1 |
| Practice expense | 4.02 | 1.137 |
| Malpractice | 0.2 | 0.579 |
(1.64 × 1 + 4.02 × 1.137 + 0.2 × 0.579) × $33.4009 = $211.31
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.64 | 1 |
| Practice expense | 2.78 | 1.137 |
| Malpractice | 0.2 | 0.579 |
(1.64 × 1 + 2.78 × 1.137 + 0.2 × 0.579) × $33.4009 = $164.22
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.
28495 billing questions
How does 28495 differ from 28490?
28495 is for closed treatment of a great-toe phalanx fracture with manipulation. Use 28490 when the fracture is treated without manipulation.
When is 28496 used instead?
28496 describes percutaneous skeletal fixation of a great-toe phalanx fracture with manipulation. 28495 is the closed-treatment code when percutaneous fixation is not performed.
Are routine related postoperative visits separately reported?
The 90-day global period includes related postoperative care, as well as the day-before preoperative visit.
Can modifier 50 be used when both great toes are treated?
CMS identifies this as a bilateral procedure; bilateral reporting with modifier 50 is paid at 150%.
Can an assistant surgeon or co-surgeon be reported?
CMS does not pay an assistant at surgery for 28495. Co-surgeons and team surgery are not permitted.
Does this code include fractures of the lesser toes?
No. This code is specific to a great-toe phalanx fracture; lesser-toe fractures are reported with codes for other toes.
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.
3,21428476,,Prq skel fix metar fx w/mnpj,A,,3.51,7.55,NA,7.55,,0.55,11.61,11.61,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,21528485,,Optx metatarsal fx each,A,,7.25,7.96,NA,7.96,,1.02,16.23,16.23,0,090,0.10,0.69,0.21,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,21628490,,Treat big toe fracture,A,,1.14,3.44,,2.65,,0.17,4.75,3.96,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,21728495,,Treat big toe fracture,A,,1.64,4.02,,2.78,,0.20,5.86,4.62,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,21828496,,Treat big toe fracture,A,,2.42,13.50,,5.49,,0.50,16.42,8.41,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,21928505,,Treat big toe fracture,A,,7.25,11.81,,5.89,,0.95,20.01,14.09,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,22028510,,Treatment of toe fracture,A,,1.14,2.63,,2.45,,0.15,3.92,3.74,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014