$114.79
Choose 28530 for closed treatment of a sesamoid fracture. Choose 28531 when the fracture is treated through open operative exposure.
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CMS RVU26D · Effective 2026-10-01
28531 Sesamoid fracture Medicare reimbursement rates in Idaho
Open surgical treatment of a fractured foot sesamoid, typically beneath the first metatarsal head, when care requires direct operative exposure. Compare 28531 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 28531 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
$301.03
1 of 1 localities have a supported rate.
Payment area: Idaho
One mapped payment locality.
Facility setting
$164.28
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.
Fracture treatment
About 28531: Open treatment of sesamoid fracture
Open surgical treatment of a fractured foot sesamoid, typically beneath the first metatarsal head, when care requires direct operative exposure.
Code 28531 represents operative treatment of a fractured sesamoid, a small bone beneath the first metatarsal head at the great-toe joint. An orthopedic foot-and-ankle surgeon or podiatric surgeon typically exposes the fracture directly and treats it surgically; internal fixation may be used when indicated. This is distinct from treating a fracture of the great-toe phalanx or a metatarsal.
Report this code for open fracture treatment rather than closed management under 28530. The operative note should identify the sesamoid fracture and describe the open treatment performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 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 is restricted; co-surgeons are permitted, while team surgery is not.
CMS billing rules for 28531
- 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 permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.51 · 26%
- Practice expense (office) RVU6.96 · 72%
- Malpractice RVU0.21 · 2%
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.
28531 compared with similar codes
Office rates for Idaho, from the same CMS release.
$620.07
This code concerns open treatment of a great-toe fracture; 28531 is for a sesamoid fracture beneath the great-toe joint.
$447.78
This code describes sesamoid excision. Code 28531 describes open treatment of a sesamoid fracture, rather than removal of the bone.
Compare 28531 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
$301.03
Facility
$164.28
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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 28531 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
3,224
- Code
- 28531
- Physician work
- 2.51
- Practice expense
- 6.96
- Malpractice
- 0.21
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.51 | × 1.000 | 2.5100 |
| Practice expense | 6.96 | × 0.920 | 6.4032 |
| Malpractice | 0.21 | × 0.473 | 0.0993 |
| Total RVUs | 9.0125 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Idaho$301.03
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.51 | 1 |
| Practice expense | 6.96 | 0.92 |
| Malpractice | 0.21 | 0.473 |
(2.51 × 1 + 6.96 × 0.92 + 0.21 × 0.473) × $33.4009 = $301.03
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.51 | 1 |
| Practice expense | 2.51 | 0.92 |
| Malpractice | 0.21 | 0.473 |
(2.51 × 1 + 2.51 × 0.92 + 0.21 × 0.473) × $33.4009 = $164.28
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.
28531 billing questions
When should 28531 be chosen over 28530?
Use 28531 for open operative treatment of the sesamoid fracture. Code 28530 describes closed treatment.
Does 28531 include internal fixation?
Yes. Internal fixation is included when performed as part of the open treatment.
What global period applies?
CMS assigns a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care.
How is bilateral treatment paid?
When both sides are treated and modifier 50 is reported, CMS pays 150%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment is barred by the statutory restriction. Co-surgeons are permitted; team surgery is not.
How does the multiple-procedure rule affect payment?
For procedures performed in the same session, the highest-valued procedure is paid in full and other procedures are paid at 50%.
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.
3,22128515,,Treatment of toe fracture,A,,1.52,3.52,,2.64,,0.18,5.22,4.34,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,22228525,,Treat toe fracture,A,,5.48,11.00,,5.38,,0.69,17.17,11.55,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,22328530,,Treat sesamoid bone fracture,A,,1.08,2.50,,1.89,,0.12,3.70,3.09,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,22428531,,Treat sesamoid bone fracture,A,,2.51,6.96,,2.51,,0.21,9.68,5.23,0,090,0.10,0.69,0.21,2,1,1,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,22528540,,Treat foot dislocation,A,,2.14,3.64,,2.80,,0.18,5.96,5.12,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,22628545,,Treat foot dislocation,A,,2.54,7.33,,5.23,,0.53,10.40,8.30,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,22728546,,Treat foot dislocation,A,,3.32,15.07,,6.69,,0.70,19.09,10.71,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,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