$125.15
Use 28510 for closed treatment of a lesser-toe phalanx fracture without manipulation; 28515 requires manipulation.
On this page
CMS RVU26D · Effective 2026-10-01
28515 Toe fracture care Medicare reimbursement rates in Utah
Report this code for closed reduction of a phalangeal fracture in a toe other than the great toe when the clinician manipulates the fracture. Compare 28515 office and facility rates across CMS payment localities in Utah.
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 28515 in Utah?
Utah 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
$166.69
1 of 1 localities have a supported rate.
Payment area: Utah
One mapped payment locality.
Facility setting
$139.06
1 of 1 localities have a supported rate.
Payment area: Utah
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.
Orthopedic treatment
About 28515: Closed lesser-toe fracture treatment with manipulation
Report this code for closed reduction of a phalangeal fracture in a toe other than the great toe when the clinician manipulates the fracture.
This service covers closed treatment of a fracture in one or more phalanges of a toe other than the great toe, with manipulation to reduce or realign the fracture. Orthopedic surgeons, podiatrists, and other clinicians who manage acute fractures may perform it in an office, emergency department, or facility. The fracture is treated without open surgical exposure; the manipulation is the feature that distinguishes this service from closed treatment without manipulation.
Report the code for each treated fracture, supporting the record with the affected toe and side, fracture findings, and the reduction or other manipulation performed. Routine related care during the 90-day global period, including the day-before preoperative visit, is included. 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 50% multiple-procedure reduction. CMS does not apply a bilateral adjustment, and modifier 50 is inappropriate. Assistant-at-surgery payment is statutorily restricted; co-surgeons and team surgery are not permitted.
CMS billing rules for 28515
- 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 adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.52 · 29%
- Practice expense (office) RVU3.52 · 67%
- Malpractice RVU0.18 · 3%
1.4K
Medicare services in 2024 · #2704 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.
28515 compared with similar codes
Office rates for Utah, from the same CMS release.
$186.99
Both describe closed treatment with manipulation, but 28495 is for the great toe and 28515 is for other toes.
$549.10
28525 is open treatment of a lesser-toe phalanx fracture. This code describes closed treatment with manipulation.
Compare 28515 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
Utah →
Office / nonfacility
$166.69
Facility
$139.06
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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 28515 in Utah.
PPRRVU2026_Oct_nonQPP.csv
3,221
- Code
- 28515
- Physician work
- 1.52
- Practice expense
- 3.52
- Malpractice
- 0.18
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.52 | × 1.000 | 1.5200 |
| Practice expense | 3.52 | × 0.940 | 3.3088 |
| Malpractice | 0.18 | × 0.898 | 0.1616 |
| Total RVUs | 4.9904 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Utah$166.69
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.52 | 1 |
| Practice expense | 3.52 | 0.94 |
| Malpractice | 0.18 | 0.898 |
(1.52 × 1 + 3.52 × 0.94 + 0.18 × 0.898) × $33.4009 = $166.69
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.52 | 1 |
| Practice expense | 2.64 | 0.94 |
| Malpractice | 0.18 | 0.898 |
(1.52 × 1 + 2.64 × 0.94 + 0.18 × 0.898) × $33.4009 = $139.06
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.
28515 billing questions
How does this differ from 28510?
28515 is for closed treatment with manipulation. Use 28510 when the lesser-toe phalanx fracture is treated without manipulation.
Can this code be used for a great toe fracture?
No. This code is for toes other than the great toe; 28495 describes closed treatment with manipulation of a great-toe fracture.
What should the documentation show?
Document the lesser toe and side, the phalangeal fracture treated, and the manipulation or reduction performed. The record should distinguish the service from treatment without manipulation.
Is routine follow-up separately reported?
Related postoperative care during the 90-day global period is included, along with the day-before preoperative visit.
Should modifier 50 be reported for fractures on both feet?
No. CMS identifies modifier 50 as inappropriate for this code, and a bilateral adjustment does not apply.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures are subject to the standard multiple-procedure reduction.
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.
3,21828496,,Treat big toe fracture,A,,2.42,13.50,,5.49,,0.50,16.42,8.41,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,21928505,,Treat big toe fracture,A,,7.25,11.81,,5.89,,0.95,20.01,14.09,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,22028510,,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
10104412,TX,15,GALVESTON,1.008,0.993,0.828
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985