$303.15
Both codes address closed treatment of a sesamoid fracture. Use 28530 when the fragments are not manipulated and 28531 when the provider manipulates them.
On this page
CMS RVU26D · Effective 2026-10-01
28530 Sesamoid fracture care Medicare reimbursement rates in Ohio
Report this service for closed treatment of a fractured foot sesamoid when the fracture is managed without manipulating the bone fragments. Compare 28530 office and facility rates across CMS payment localities in Ohio.
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 28530 in Ohio?
Ohio 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
$116.35
1 of 1 localities have a supported rate.
Payment area: Ohio
One mapped payment locality.
Facility setting
$97.75
1 of 1 localities have a supported rate.
Payment area: Ohio
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 fracture care
About 28530: Closed sesamoid fracture treatment without manipulation
Report this service for closed treatment of a fractured foot sesamoid when the fracture is managed without manipulating the bone fragments.
This code describes closed management of a fractured sesamoid without manipulating the bone fragments. Sesamoids are small bones beneath the first metatarsal head; a patient may present with pain and tenderness under the ball of the foot after an injury. Orthopedic surgeons, podiatrists, and other qualified clinicians may provide the fracture care in an office, clinic, or facility setting. The service is distinct from treatment of a toe phalanx fracture, even when symptoms are near the great toe.
Select this code when the provider documents a sesamoid fracture and closed treatment without manipulation. The record should identify the fracture site and show the treatment plan; use the manipulation code when the fragments are manipulated instead. CMS 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 one session, the highest-valued is paid in full and others at 50%. Bilateral reporting with 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 28530
- 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 RVU1.08 · 29%
- Practice expense (office) RVU2.50 · 68%
- Malpractice RVU0.12 · 3%
109
Medicare services in 2024 · #4813 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.
28530 compared with similar codes
Office rates for Ohio, from the same CMS release.
$123.33
28510 is for a lesser-toe phalanx fracture treated closed without manipulation. 28530 is for the sesamoid, not a toe phalanx.
$148.70
28490 concerns a great-toe phalanx fracture treated closed without manipulation. Choose 28530 when the injured bone is a sesamoid.
$634.29
28505 describes open treatment of a great-toe fracture. 28530 is closed treatment of a sesamoid fracture without manipulation.
Compare 28530 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
Ohio →
Office / nonfacility
$116.35
Facility
$97.75
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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 28530 in Ohio.
PPRRVU2026_Oct_nonQPP.csv
3,223
- Code
- 28530
- Physician work
- 1.08
- Practice expense
- 2.50
- Malpractice
- 0.12
GPCI2026.csv
85
- Locality
- Ohio
- Physician work
- 1.000
- Practice expense
- 0.913
- Malpractice
- 1.008
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.08 | × 1.000 | 1.0800 |
| Practice expense | 2.50 | × 0.913 | 2.2825 |
| Malpractice | 0.12 | × 1.008 | 0.1210 |
| Total RVUs | 3.4835 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Ohio$116.35
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.08 | 1 |
| Practice expense | 2.5 | 0.913 |
| Malpractice | 0.12 | 1.008 |
(1.08 × 1 + 2.5 × 0.913 + 0.12 × 1.008) × $33.4009 = $116.35
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.08 | 1 |
| Practice expense | 1.89 | 0.913 |
| Malpractice | 0.12 | 1.008 |
(1.08 × 1 + 1.89 × 0.913 + 0.12 × 1.008) × $33.4009 = $97.75
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.
28530 billing questions
How is 28530 different from 28531?
28530 is for closed treatment of a sesamoid fracture without manipulation. Choose 28531 when the provider manipulates the fracture.
Can this code be used for a great toe phalanx fracture?
No. 28530 is for a sesamoid fracture. A fracture of a toe phalanx is coded from the toe-fracture family, based on the bone and treatment performed.
Are related postoperative visits included?
Yes. CMS assigns 28530 a 90-day global period that includes the day-before preoperative visit and 90 days of related postoperative care.
How is bilateral treatment reported?
CMS identifies this as a bilateral procedure; modifier 50 is paid at 150%. Document treatment of both sides.
When is assistant-at-surgery payment allowed?
CMS allows assistant-at-surgery payment only when medical necessity is documented. Co-surgeons and team surgery are not permitted.
What happens when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.
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.
3,22028510,,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
3,22628545,,Treat foot dislocation,A,,2.54,7.33,,5.23,,0.53,10.40,8.30,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8213282,NY,99,REST OF NEW YORK,1.000,0.950,0.703
8311502,NC,00,NORTH CAROLINA,1.000,0.933,0.639
8403302,ND,01,NORTH DAKOTA**,1.000,1.000,0.406
8515202,OH,00,OHIO,1.000,0.913,1.008
8604312,OK,00,OKLAHOMA,1.000,0.893,0.777
8702302,OR,01,PORTLAND,1.016,1.111,0.744
8802302,OR,99,REST OF OREGON,1.000,0.996,0.703