Billing code 28052: Joint biopsyMedicare rate & RVUs in Illinois
Report this service when a surgeon opens a metatarsophalangeal joint to obtain synovial tissue for diagnostic evaluation.
Medicare pays $367.05–$398.35 for 28052 in the office in Illinois, from Rest Of Illinois to Chicago. 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 28052 covers
A foot and ankle surgeon, orthopedic surgeon, or podiatric surgeon opens a metatarsophalangeal joint and takes a sample of its synovial lining. The tissue may be sent for evaluation when the cause of joint inflammation or another abnormal process remains uncertain. This is an open joint procedure, not simply a needle sample or inspection of the joint. The code is specific to the metatarsophalangeal joint; the operative report should identify the joint and document the tissue sampled.
Report the service for the joint actually biopsied, supported by the operative note and specimen documentation. Medicare assigns 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 with modifier 50, CMS pays at 150%. Medicare does not pay an assistant at surgery for this code. Co-surgeon payment requires supporting documentation, and team surgery is 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 28052 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$367.05 to $398.35
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $398.35 | $259.05 |
| East St. Louis | $373.99 | $246.46 |
| Rest Of Illinois | $367.05 | $240.50 |
| Suburban Chicago | $397.46 | $255.10 |
How the 28052 rate is calculated
Each of 28052’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 · 28052
RVUs × geographic indexes × conversion factor
Work3.96
3.96 RVUs× 1.000 GPCI
Practice expense7.10
7.10 RVUs× 1.000 GPCI
Malpractice0.35
0.35 RVUs× 1.000 GPCI
Adjusted RVUs
11.4100
Conversion factor
$33.4009
Medicare rate
$381.10
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 28052
28052 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 28052
Joint biopsy
| 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) | 1 | Permitted with supporting documentation. |
| 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 · 28052
Joint biopsy
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
28052 without 50 · national office
$381.10
Joint biopsy
28052-50 · Bilateral: 150%
$571.65
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).
28052 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 28050Joint biopsy
- Choose 28050 for the other specified foot-joint site. This code is for a metatarsophalangeal joint; confirm the site in the operative report.
- 28054Joint biopsy
- Choose 28054 when the biopsied joint is an interphalangeal joint in a toe. This code is for a metatarsophalangeal joint.
- 28072Joint synovectomy
- Code 28072 represents removal of metatarsophalangeal joint lining. This code describes diagnostic sampling rather than removal of the lining as treatment.
28052 billing questions
How is this code distinguished from 28050?
This code is for biopsy of a metatarsophalangeal joint lining. Code 28050 is for a different foot-joint site, so the operative report must identify the joint entered.
How is this code distinguished from 28054?
Use this code for a metatarsophalangeal joint biopsy and 28054 for an interphalangeal toe-joint biopsy. The documented joint site determines the choice.
Can the biopsy be reported separately from the joint procedure?
The joint exposure and synovial sampling are represented by this service; do not separately report another biopsy procedure for the same tissue collection.
What documentation supports reporting this code?
Document the metatarsophalangeal joint entered, the open approach, the synovial tissue obtained, and the reason for diagnostic sampling.
How does Medicare handle bilateral reporting and other procedures in the session?
CMS pays bilateral reporting with modifier 50 at 150%. For multiple procedures in one session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction.
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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