Billing code 28531: Sesamoid fractureMedicare rate & RVUs in Oregon
Open surgical treatment of a fractured foot sesamoid, typically beneath the first metatarsal head, when care requires direct operative exposure.
Medicare pays $320.31–$348.67 for 28531 in the office in Oregon, from Rest Of Oregon to Portland. 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 28531 covers
Code 28531 represents operative treatment of a fractured sesamoid, a small bone beneath the first metatarsal head at the great-toe joint. An orthopedic foot-and-ankle surgeon or podiatric surgeon typically exposes the fracture directly and treats it surgically; internal fixation may be used when indicated. This is distinct from treating a fracture of the great-toe phalanx or a metatarsal.
Report this code for open fracture treatment rather than closed management under 28530. The operative note should identify the sesamoid fracture and describe the open treatment performed. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. In a same-session multiple-procedure case, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; co-surgeons are permitted, while team surgery is not.
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.
Where 28531 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | $348.67 | $183.54 |
| Rest Of Oregon | $320.31 | $172.27 |
How the 28531 rate is calculated
Each of 28531’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 · 28531
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.51Practice expense 6.96Malpractice 0.21
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 28531
28531 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 28531
Sesamoid fracture
| 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) | 2 | 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 · 28531
Sesamoid fracture
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
28531 without 50 · national office
$323.32
Sesamoid fracture
28531-50 · Bilateral: 150%
$484.98
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).
28531 compared with similar codes
Compare codes
28531 vs 28530 vs 28505 vs 28315: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 28530Sesamoid fracture care
- Choose 28530 for closed treatment of a sesamoid fracture. Choose 28531 when the fracture is treated through open operative exposure.
- 28505Toe fracture surgery
- This code concerns open treatment of a great-toe fracture; 28531 is for a sesamoid fracture beneath the great-toe joint.
- 28315Sesamoidectomy
- This code describes sesamoid excision. Code 28531 describes open treatment of a sesamoid fracture, rather than removal of the bone.
28531 billing questions
When should 28531 be chosen over 28530?
Use 28531 for open operative treatment of the sesamoid fracture. Code 28530 describes closed treatment.
Does 28531 include internal fixation?
Yes. Internal fixation is included when performed as part of the open treatment.
What global period applies?
CMS assigns a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care.
How is bilateral treatment paid?
When both sides are treated and modifier 50 is reported, CMS pays 150%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment is barred by the statutory restriction. Co-surgeons are permitted; team surgery is not.
How does the multiple-procedure rule affect payment?
For procedures performed in the same session, the highest-valued procedure is paid in full and 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 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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