Billing code 28645: Toe dislocation repairMedicare rate & RVUs in Ohio
Reports open surgical reduction and repair of a dislocated toe metatarsophalangeal joint, including internal fixation when performed.
Medicare pays $632.30 for 28645 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 28645 covers
This service treats a dislocation of a toe’s metatarsophalangeal joint through an open surgical approach. The surgeon exposes the joint, restores alignment, and addresses the dislocation; internal fixation may be used when needed. Orthopedic surgeons and podiatric surgeons commonly perform the procedure in an operating room, often when the joint requires open treatment rather than closed reduction.
Report the code for open treatment of a metatarsophalangeal dislocation, not for closed reduction or for an open dislocation of an interphalangeal joint. The operative note should identify the affected toe and joint, describe the open approach and treatment, and document any fixation. Medicare 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 the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment is restricted; co-surgeon payment requires supporting documentation, and team surgery is 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.
28645 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | $632.30 | $445.06 |
How the 28645 rate is calculated
Each of 28645’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 · 28645
RVUs × geographic indexes × conversion factor
Work7.25
7.25 RVUs× 1.000 GPCI
Practice expense11.80
11.80 RVUs× 1.000 GPCI
Malpractice0.90
0.90 RVUs× 1.000 GPCI
Adjusted RVUs
19.9500
Conversion factor
$33.4009
Medicare rate
$666.35
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 28645
28645 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 28645
Toe dislocation repair
| 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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| 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 · 28645
Toe dislocation repair
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 51 · payment effect
With and without the modifier
28645 without 51 · national office
$666.35
Toe dislocation repair
28645-51 · Second procedure: 50%
$333.18
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
28645 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 28636Toe dislocation
- Choose 28645 for open treatment of the metatarsophalangeal joint. Choose 28636 when the dislocation is treated closed with percutaneous skeletal fixation.
- 28635Toe dislocation
- Code 28635 describes closed treatment of a metatarsophalangeal dislocation with anesthesia; 28645 is for open surgical treatment.
- 28675Toe dislocation repair
- Both involve open treatment, but 28675 is for an interphalangeal joint dislocation. Code 28645 is for a metatarsophalangeal joint dislocation.
28645 billing questions
When should I report 28645 instead of 28636?
Use 28645 for open treatment of a metatarsophalangeal joint dislocation. Code 28636 describes closed treatment with percutaneous skeletal fixation.
How does 28645 differ from 28675?
The joint determines the choice: 28645 is for an open metatarsophalangeal dislocation, while 28675 is for an open interphalangeal dislocation.
What documentation supports reporting 28645?
Document the affected toe and metatarsophalangeal joint, the dislocation, the open surgical treatment, and any fixation performed.
Can modifier 50 be reported for bilateral toe treatment?
No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 should not be used.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are multiple procedures handled in the same session?
The highest-valued procedure is paid in full, and other procedures are paid at 50%. Assistant-at-surgery payment is restricted; co-surgeon payment requires supporting documentation.
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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