CPT code 28530: Sesamoid fracture care2026 Medicare rate & RVUs in Utah
Report this service for closed treatment of a fractured foot sesamoid when the fracture is managed without manipulating the bone fragments.
Medicare pays $118.16 for 28530 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 28530 covers
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.
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 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | $118.16 | $99.01 |
How the 28530 rate is calculated
Each of 28530’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 · 28530
RVUs × geographic indexes × conversion factor
Work1.08
1.08 RVUs× 1.000 GPCI
Practice expense2.50
2.50 RVUs× 1.000 GPCI
Malpractice0.12
0.12 RVUs× 1.000 GPCI
Adjusted RVUs
3.7000
Conversion factor
$33.4009
Medicare rate
$123.58
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 28530
28530 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 28530
Sesamoid fracture care
| 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) | 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 · 28530
Sesamoid fracture care
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
28530 without 50 · national office
$123.58
Sesamoid fracture care
28530-50 · Bilateral: 150%
$185.37
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).
28530 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 28531Sesamoid fracture
- Both codes address closed treatment of a sesamoid fracture. Use 28530 when the fragments are not manipulated and 28531 when the provider manipulates them.
- 28510Toe fracture care
- 28510 is for a lesser-toe phalanx fracture treated closed without manipulation. 28530 is for the sesamoid, not a toe phalanx.
- 28490Toe fracture care
- 28490 concerns a great-toe phalanx fracture treated closed without manipulation. Choose 28530 when the injured bone is a sesamoid.
- 28505Toe fracture surgery
- 28505 describes open treatment of a great-toe fracture. 28530 is closed treatment of a sesamoid fracture without manipulation.
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 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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