Billing code 28495: Toe fracture treatmentMedicare rate & RVUs in Ohio
Closed reduction and treatment of a great-toe phalanx fracture when the provider manipulates the fracture without open exposure or percutaneous fixation.
Medicare pays $184.10 for 28495 in the office in Ohio (Ohio). 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 28495 covers
Code 28495 represents closed treatment of a fracture in a great-toe phalanx when the clinician manipulates the fracture to restore alignment. The provider may use manual reduction and then immobilize the toe, such as with taping, a rigid-soled shoe, or a splint. Typical cases include a displaced hallux phalanx fracture managed without an incision or percutaneous hardware. Orthopedic surgeons, podiatrists, and other clinicians qualified to manage fractures may perform this service in an office, emergency department, or facility setting.
Report the code for a great-toe phalanx fracture and document the fracture site and manipulation performed. CMS assigns a 90-day major-surgery global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. CMS does not pay an assistant at surgery for this code; co-surgeons and team surgery are 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.
28495 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | $184.10 | $146.29 |
How the 28495 rate is calculated
Each of 28495’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 · 28495
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.64Practice expense 4.02Malpractice 0.20
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 28495
28495 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 28495
Toe fracture treatment
| 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) | 0 | Not permitted. |
| 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 · 28495
Toe fracture treatment
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
28495 without 50 · national office
$195.73
Toe fracture treatment
28495-50 · Bilateral: 150%
$293.60
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).
28495 compared with similar codes
Compare codes
28495 vs 28490 vs 28496 vs 28475: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 28490Toe fracture care
- Both codes treat great-toe phalanx fractures without open exposure. Choose 28495 when the provider manipulates the fracture; 28490 is for treatment without manipulation.
- 28496Great toe fracture
- 28496 includes percutaneous skeletal fixation with manipulation. Use 28495 for closed treatment with manipulation when that fixation is not performed.
- 28475Metatarsal fracture
- 28475 concerns a metatarsal fracture treated with manipulation, not a phalanx fracture of the great toe.
28495 billing questions
How does 28495 differ from 28490?
28495 is for closed treatment of a great-toe phalanx fracture with manipulation. Use 28490 when the fracture is treated without manipulation.
When is 28496 used instead?
28496 describes percutaneous skeletal fixation of a great-toe phalanx fracture with manipulation. 28495 is the closed-treatment code when percutaneous fixation is not performed.
Are routine related postoperative visits separately reported?
The 90-day global period includes related postoperative care, as well as the day-before preoperative visit.
Can modifier 50 be used when both great toes are treated?
CMS identifies this as a bilateral procedure; bilateral reporting with modifier 50 is paid at 150%.
Can an assistant surgeon or co-surgeon be reported?
CMS does not pay an assistant at surgery for 28495. Co-surgeons and team surgery are not permitted.
Does this code include fractures of the lesser toes?
No. This code is specific to a great-toe phalanx fracture; lesser-toe fractures are reported with codes for other toes.
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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