Billing code 28525: Toe fracture repairMedicare rate & RVUs in Utah
Surgical exposure and treatment of a fracture in a toe other than the great toe, with internal fixation included when performed.
Medicare pays $549.10 for 28525 in the office in Utah (Utah). 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 28525 covers
This service treats a fracture of a lesser-toe phalanx by surgically exposing the fracture and addressing its alignment. Internal fixation, such as pins or screws, is included when performed. “Open treatment” refers to the surgical approach; it does not mean the injury itself must be an open wound. Orthopedic surgeons and podiatrists may perform the procedure, commonly in an operating room for a displaced or unstable lesser-toe fracture requiring operative treatment.
Report this code for open treatment of a phalanx fracture in a toe other than the great toe; use the operative report to support the toe and fracture site, surgical exposure, reduction, and any fixation. The 90-day global period includes 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 other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment requires documentation of medical necessity; 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.
28525 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | $549.10 | $372.65 |
How the 28525 rate is calculated
Each of 28525’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 · 28525
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 5.48Practice expense 11.00Malpractice 0.69
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 28525
28525 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 28525
Toe fracture 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) | 0 | Not paid without supporting documentation. |
| 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 · 28525
Toe fracture 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
28525 without 51 · national office
$573.49
Toe fracture repair
28525-51 · Second procedure: 50%
$286.75
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%).
28525 compared with similar codes
Compare codes
28525 vs 28505 vs 28510 vs 28515: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 28505Toe fracture surgery
- Use 28505 for open treatment of a great-toe phalanx fracture. Use 28525 for a phalanx fracture in another toe.
- 28510Toe fracture care
- Code 28510 describes closed treatment of a lesser-toe fracture without manipulation; 28525 describes open surgical treatment.
- 28515Toe fracture care
- Code 28515 describes closed treatment of a lesser-toe fracture with manipulation. Surgical exposure and treatment point to 28525 instead.
28525 billing questions
How is this different from code 28505?
Code 28525 is for open treatment of a fracture in a toe other than the great toe. Code 28505 is the corresponding open-treatment code for a great-toe fracture.
Is internal fixation separately reported?
Internal fixation is included in this service when performed. The operative report should describe the reduction and any pins, screws, or other fixation used.
How does this differ from codes 28510 and 28515?
Those codes describe closed treatment of a lesser-toe fracture, without manipulation for 28510 and with manipulation for 28515. Code 28525 describes open surgical treatment.
Can modifier 50 be used for fractures in both feet?
CMS identifies bilateral adjustment as inappropriate for this code based on its descriptor or anatomy. Modifier 50 should not be applied.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
When is assistant-at-surgery payment allowed?
Payment for an assistant at surgery requires documentation of medical necessity. Co-surgeons and team surgery are not permitted for this code.
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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