$615.69
Use 28505 for open treatment of a great-toe phalanx fracture. Use 28525 for a phalanx fracture in another toe.
On this page
CMS RVU26D · Effective 2026-10-01
28525 Toe fracture repair Medicare reimbursement rates in Iowa
Surgical exposure and treatment of a fracture in a toe other than the great toe, with internal fixation included when performed. Compare 28525 office and facility rates across CMS payment localities in Iowa.
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 28525 in Iowa?
Iowa 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
$528.37
1 of 1 localities have a supported rate.
Payment area: Iowa
One mapped payment locality.
Facility setting
$356.61
1 of 1 localities have a supported rate.
Payment area: Iowa
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.
Orthopedic surgery
About 28525: Open treatment of lesser toe fracture
Surgical exposure and treatment of a fracture in a toe other than the great toe, with internal fixation included when performed.
This service treats a fracture of a lesser-toe phalanx by surgically exposing the fracture and addressing its alignment. Internal fixation, such as pins or screws, is included when performed. “Open treatment” refers to the surgical approach; it does not mean the injury itself must be an open wound. Orthopedic surgeons and podiatrists may perform the procedure, commonly in an operating room for a displaced or unstable lesser-toe fracture requiring operative treatment.
Report this code for open treatment of a phalanx fracture in a toe other than the great toe; use the operative report to support the toe and fracture site, surgical exposure, reduction, and any fixation. 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 50% multiple-procedure reduction. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 28525
- 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
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU5.48 · 32%
- Practice expense (office) RVU11.00 · 64%
- Malpractice RVU0.69 · 4%
330
Medicare services in 2024 · #3920 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.
28525 compared with similar codes
Office rates for Iowa, from the same CMS release.
$120.44
Code 28510 describes closed treatment of a lesser-toe fracture without manipulation; 28525 describes open surgical treatment.
$160.73
Code 28515 describes closed treatment of a lesser-toe fracture with manipulation. Surgical exposure and treatment point to 28525 instead.
Compare 28525 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
Iowa →
Office / nonfacility
$528.37
Facility
$356.61
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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 28525 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
3,222
- Code
- 28525
- Physician work
- 5.48
- Practice expense
- 11.00
- Malpractice
- 0.69
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.48 | × 1.000 | 5.4800 |
| Practice expense | 11.00 | × 0.915 | 10.0650 |
| Malpractice | 0.69 | × 0.397 | 0.2739 |
| Total RVUs | 15.8189 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Iowa$528.37
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.48 | 1 |
| Practice expense | 11 | 0.915 |
| Malpractice | 0.69 | 0.397 |
(5.48 × 1 + 11 × 0.915 + 0.69 × 0.397) × $33.4009 = $528.37
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.48 | 1 |
| Practice expense | 5.38 | 0.915 |
| Malpractice | 0.69 | 0.397 |
(5.48 × 1 + 5.38 × 0.915 + 0.69 × 0.397) × $33.4009 = $356.61
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.
28525 billing questions
How is this different from code 28505?
Code 28525 is for open treatment of a fracture in a toe other than the great toe. Code 28505 is the corresponding open-treatment code for a great-toe fracture.
Is internal fixation separately reported?
Internal fixation is included in this service when performed. The operative report should describe the reduction and any pins, screws, or other fixation used.
How does this differ from codes 28510 and 28515?
Those codes describe closed treatment of a lesser-toe fracture, without manipulation for 28510 and with manipulation for 28515. Code 28525 describes open surgical treatment.
Can modifier 50 be used for fractures in both feet?
CMS identifies bilateral adjustment as inappropriate for this code based on its descriptor or anatomy. Modifier 50 should not be applied.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
When is assistant-at-surgery payment allowed?
Payment for an assistant at surgery requires documentation of medical necessity. Co-surgeons and team surgery are not permitted for this code.
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.
3,21928505,,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
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
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
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136