$334.07
Choose 28054 when the biopsied joint is in a toe. This code is for a foot joint.
On this page
CMS RVU26D · Effective 2026-10-01
28050 Joint biopsy Medicare reimbursement rates in Idaho
Report this procedure when a surgeon samples the lining of a foot joint for diagnostic evaluation rather than removing the lining therapeutically. Compare 28050 office and facility rates across CMS payment localities in Idaho.
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 28050 in Idaho?
Idaho 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
$380.50
1 of 1 localities have a supported rate.
Payment area: Idaho
One mapped payment locality.
Facility setting
$248.06
1 of 1 localities have a supported rate.
Payment area: Idaho
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 28050: Foot joint lining biopsy
Report this procedure when a surgeon samples the lining of a foot joint for diagnostic evaluation rather than removing the lining therapeutically.
A surgeon obtains tissue from the lining of a foot joint so it can be examined for causes of joint disease, such as unexplained inflammation or suspected infection. Orthopedic surgeons and podiatrists may perform the biopsy in an operating room or another surgical setting. The sampled tissue may be sent for pathology or other appropriate testing. This service concerns a foot joint; a biopsy of a toe joint is represented separately.
Select the code based on the documented joint and the procedure actually performed. The operative note should identify the foot joint, the tissue sampled, and the diagnostic purpose; a therapeutic removal of joint lining is a different service. This code has 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, modifier 50 is paid at 150%. Medicare does not pay an assistant at surgery; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 28050
- 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 RVU4.28 · 35%
- Practice expense (office) RVU7.54 · 62%
- Malpractice RVU0.37 · 3%
53
Medicare services in 2024 · #5318 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.
28050 compared with similar codes
Office rates for Idaho, from the same CMS release.
$521.67
This code represents sampling joint lining for diagnostic evaluation; 28020 represents exploration of a foot joint.
$482.06
A biopsy obtains tissue for evaluation. 28070 describes removal of foot joint lining as a therapeutic procedure.
Compare 28050 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
Idaho →
Office / nonfacility
$380.50
Facility
$248.06
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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 28050 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
3,104
- Code
- 28050
- Physician work
- 4.28
- Practice expense
- 7.54
- Malpractice
- 0.37
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.28 | × 1.000 | 4.2800 |
| Practice expense | 7.54 | × 0.920 | 6.9368 |
| Malpractice | 0.37 | × 0.473 | 0.1750 |
| Total RVUs | 11.3918 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Idaho$380.50
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.28 | 1 |
| Practice expense | 7.54 | 0.92 |
| Malpractice | 0.37 | 0.473 |
(4.28 × 1 + 7.54 × 0.92 + 0.37 × 0.473) × $33.4009 = $380.50
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.28 | 1 |
| Practice expense | 3.23 | 0.92 |
| Malpractice | 0.37 | 0.473 |
(4.28 × 1 + 3.23 × 0.92 + 0.37 × 0.473) × $33.4009 = $248.06
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.
28050 billing questions
How is a foot joint biopsy different from a toe joint biopsy?
This code is for sampling the lining of a foot joint. Use the separate toe-joint biopsy code, 28054, when the sampled joint is in a toe.
Can the surgeon also report a synovectomy?
A diagnostic tissue sample is distinct from therapeutic removal of joint lining. Report a separate synovectomy only when it is independently performed and documented, rather than treating the biopsy itself as a synovectomy.
Does joint exploration include a biopsy?
Exploration codes describe inspection or exploration of a joint, while this code represents obtaining tissue from the joint lining. The operative note should support each service reported.
What should the operative note document?
Document the specific foot joint, the tissue sampled, and the diagnostic reason for obtaining the specimen. The record should make clear that tissue was sampled rather than the lining being removed therapeutically.
How does Medicare handle bilateral reporting and multiple procedures?
Modifier 50 is subject to the bilateral payment rule of 150%. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and the others are reduced to 50%.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeon payment requires supporting documentation; team surgery is 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 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.
3,10128045,,Exc foot/toe tum deep <1.5cm,A,,5.31,8.67,,4.01,,0.54,14.52,9.86,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,10228046,,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
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
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772