$388.74
This code concerns a foot-joint lining biopsy; 28054 is for a toe-joint lining biopsy. Base selection on the joint sampled and the full code descriptor.
On this page
CMS RVU26D · Effective 2026-10-01
28054 Joint biopsy Medicare reimbursement rates in New Mexico
Reports surgical sampling of synovial lining from a toe joint when tissue is needed to investigate a joint condition. Compare 28054 office and facility rates across CMS payment localities in New Mexico.
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 28054 in New Mexico?
New Mexico 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
$340.43
1 of 1 localities have a supported rate.
Payment area: New Mexico
One mapped payment locality.
Facility setting
$216.39
1 of 1 localities have a supported rate.
Payment area: New Mexico
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 28054: Toe joint lining biopsy
Reports surgical sampling of synovial lining from a toe joint when tissue is needed to investigate a joint condition.
A surgeon obtains a tissue sample from the synovial lining of a toe joint for diagnostic evaluation. This may be performed by a podiatric surgeon or an orthopedic foot and ankle surgeon in an operating room when a joint disorder requires tissue examination, such as suspected inflammatory or proliferative synovial disease. The specimen is submitted for examination; the service is sampling, not removal of the joint lining as treatment.
Report the code when the operative record identifies the toe joint sampled and documents that lining tissue was obtained for biopsy. It has a 90-day global period, including the day-before preoperative visit and 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. For bilateral reporting, modifier 50 is paid at 150%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 28054
- 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
- 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 RVU3.48 · 32%
- Practice expense (office) RVU6.94 · 65%
- Malpractice RVU0.29 · 3%
34
Medicare services in 2024 · #5578 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.
28054 compared with similar codes
Office rates for New Mexico, from the same CMS release.
$363.77
Code 28052 is another foot-joint lining biopsy code. Code 28054 identifies biopsy of toe-joint lining.
$450.88
Code 28024 describes exploration of a toe joint. Use 28054 when the operative service includes sampling the joint lining for diagnostic evaluation.
$478.62
Code 28072 concerns removal of toe-joint lining, whereas 28054 represents biopsy sampling rather than therapeutic removal.
Compare 28054 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
New Mexico →
Office / nonfacility
$340.43
Facility
$216.39
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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 28054 in New Mexico.
PPRRVU2026_Oct_nonQPP.csv
3,106
- Code
- 28054
- Physician work
- 3.48
- Practice expense
- 6.94
- Malpractice
- 0.29
GPCI2026.csv
77
- Locality
- New Mexico
- Physician work
- 1.000
- Practice expense
- 0.917
- Malpractice
- 1.201
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.48 | × 1.000 | 3.4800 |
| Practice expense | 6.94 | × 0.917 | 6.3640 |
| Malpractice | 0.29 | × 1.201 | 0.3483 |
| Total RVUs | 10.1923 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, New Mexico$340.43
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.48 | 1 |
| Practice expense | 6.94 | 0.917 |
| Malpractice | 0.29 | 1.201 |
(3.48 × 1 + 6.94 × 0.917 + 0.29 × 1.201) × $33.4009 = $340.43
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.48 | 1 |
| Practice expense | 2.89 | 0.917 |
| Malpractice | 0.29 | 1.201 |
(3.48 × 1 + 2.89 × 0.917 + 0.29 × 1.201) × $33.4009 = $216.39
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.
28054 billing questions
How is this different from a foot-joint lining biopsy?
This code is for tissue sampled from a toe joint. Codes 28050 and 28052 describe foot-joint lining biopsies; select according to the joint and the applicable full code descriptor.
When would a toe-joint exploration code be used instead?
Code 28024 describes exploration of a toe joint. Report 28054 when synovial lining tissue is sampled for diagnostic evaluation, rather than reporting exploration alone.
How does biopsy differ from removal of toe-joint lining?
A biopsy takes tissue for diagnosis. Code 28072 is associated with removal of toe-joint lining as a therapeutic procedure.
What documentation supports reporting this code?
The operative note should identify the toe joint, describe obtaining synovial lining tissue, and state the diagnostic reason for the sample.
How is bilateral performance reported?
CMS treats this as a bilateral procedure: modifier 50 is paid at 150% when the procedure is performed bilaterally.
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.
3,10328047,,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
3,10828060,,Partial removal foot fascia,A,,5.27,9.84,,4.41,,0.61,15.72,10.29,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,10928062,,Removal of foot fascia,A,,6.52,10.40,,4.32,,0.66,17.58,11.50,0,090,0.10,0.69,0.21,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7414312,NH,40,NEW HAMPSHIRE,1.000,1.041,0.875
7512402,NJ,01,NORTHERN NJ,1.063,1.160,1.068
7612402,NJ,99,REST OF NEW JERSEY,1.040,1.092,1.097
7704212,NM,05,NEW MEXICO,1.000,0.917,1.201
7813202,NY,01,MANHATTAN,1.064,1.162,1.586
7913202,NY,02,NYC SUBURBS/LONG ISLAND,1.064,1.189,1.857
8013202,NY,03,POUGHKPSIE/N NYC SUBURBS,1.045,1.095,1.210