$438.78
Choose 28092 for a toe lesion involving tendon or capsule; 28090 is the related service for a lesion involving the foot.
On this page
CMS RVU26D · Effective 2026-10-01
28092 Toe lesion excision Medicare reimbursement rates in Indiana
Excision of a localized toe lesion involving tendon or joint capsule, reported when the operative work removes that structure rather than a size-defined soft-tissue tumor. Compare 28092 office and facility rates across CMS payment localities in Indiana.
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 28092 in Indiana?
Indiana 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
$394.93
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
Facility setting
$245.07
1 of 1 localities have a supported rate.
Payment area: Indiana
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 and toe surgery
About 28092: Toe lesion excision involving tendon or capsule
Excision of a localized toe lesion involving tendon or joint capsule, reported when the operative work removes that structure rather than a size-defined soft-tissue tumor.
This procedure removes a localized lesion involving a toe tendon or joint capsule. Podiatrists and orthopedic foot-and-ankle surgeons commonly perform it for a symptomatic lesion requiring operative excision, in an office procedure setting or operating room depending on the case. The operative note should identify the toe, lesion, involved structure, and extent of removal.
Report the service when the excised lesion and operative anatomy support this tendon-or-capsule procedure, rather than a soft-tissue tumor code selected by depth and size. The 90-day global period includes 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 multiple-procedure reduction. Do not report modifier 50 for this service. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
CMS billing rules for 28092
- 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 adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- 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 RVU3.69 · 29%
- Practice expense (office) RVU8.57 · 68%
- Malpractice RVU0.39 · 3%
1.2K
Medicare services in 2024 · #2825 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.
28092 compared with similar codes
Office rates for Indiana, from the same CMS release.
$357.73
28043 describes excision of a qualifying superficial soft-tissue tumor under the applicable size threshold. Use 28092 when the operative target is a toe lesion involving tendon or capsule.
$454.57
28045 describes excision of a qualifying deep soft-tissue tumor under the applicable size threshold. This code instead identifies a toe lesion involving tendon or capsule.
Compare 28092 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
Indiana →
Office / nonfacility
$394.93
Facility
$245.07
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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 28092 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
3,116
- Code
- 28092
- Physician work
- 3.69
- Practice expense
- 8.57
- Malpractice
- 0.39
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.69 | × 1.000 | 3.6900 |
| Practice expense | 8.57 | × 0.927 | 7.9444 |
| Malpractice | 0.39 | × 0.486 | 0.1895 |
| Total RVUs | 11.8239 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Indiana$394.93
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.69 | 1 |
| Practice expense | 8.57 | 0.927 |
| Malpractice | 0.39 | 0.486 |
(3.69 × 1 + 8.57 × 0.927 + 0.39 × 0.486) × $33.4009 = $394.93
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.69 | 1 |
| Practice expense | 3.73 | 0.927 |
| Malpractice | 0.39 | 0.486 |
(3.69 × 1 + 3.73 × 0.927 + 0.39 × 0.486) × $33.4009 = $245.07
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.
28092 billing questions
How does this differ from 28090?
28092 is for a lesion involving a toe tendon or capsule; 28090 is the corresponding excision service for the foot. Document the actual site and structure treated.
When should a soft-tissue tumor code be considered instead?
Consider codes such as 28043 or 28045 when the service is excision of a soft-tissue tumor and the applicable depth and size criteria support that code. This code describes a lesion involving toe tendon or capsule.
Is modifier 50 appropriate for both toes?
No. CMS identifies bilateral adjustment as inappropriate for this descriptor or anatomy; do not append modifier 50.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.
How are other procedures paid when performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure 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 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.
3,11328086,,Excise foot tendon sheath,A,,4.80,10.73,,4.60,,0.65,16.18,10.05,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,11428088,,Excise foot tendon sheath,A,,3.88,10.04,,4.16,,0.50,14.42,8.54,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,11528090,,Removal of foot lesion,A,,4.44,9.13,,3.90,,0.48,14.05,8.82,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,11628092,,Removal of toe lesions,A,,3.69,8.57,,3.73,,0.39,12.65,7.81,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,11728100,,Removal of ankle/heel lesion,A,,5.68,12.75,,5.51,,0.89,19.32,12.08,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,11828102,,Remove/graft foot lesion,A,,7.72,8.10,NA,8.10,,1.64,17.46,17.46,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,11928103,,Remove/graft foot lesion,A,,6.50,3.78,NA,3.78,,0.55,10.83,10.83,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915