$154.70
Use 28490 for closed treatment of a great toe fracture without manipulation. Use 28496 when manipulation and percutaneous skeletal fixation are performed.
On this page
CMS RVU26D · Effective 2026-10-01
28496 Great toe fracture Medicare reimbursement rates in Vermont
Percutaneous skeletal fixation with manipulation treats a great toe fracture when the fracture requires reduction and pin fixation rather than closed treatment alone. Compare 28496 office and facility rates across CMS payment localities in Vermont.
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 28496 in Vermont?
Vermont 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
$535.68
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
Facility setting
$270.82
1 of 1 localities have a supported rate.
Payment area: Vermont
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 surgery
About 28496: Great toe fracture percutaneous fixation
Percutaneous skeletal fixation with manipulation treats a great toe fracture when the fracture requires reduction and pin fixation rather than closed treatment alone.
An orthopedic surgeon or podiatric surgeon uses manipulation to reduce a great toe fracture and places skeletal fixation through the skin, typically with pins, to stabilize the fracture. This approach is used when the fracture needs fixation but is treated percutaneously rather than through open exposure. The service is generally performed in a surgical facility; the 2024 Medicare file reports facility services for this code.
Choose this code when the documented treatment includes both manipulation and percutaneous skeletal fixation of a great toe fracture. The operative report should identify the great toe fracture, reduction, and percutaneous fixation performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For same-session procedures, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; co-surgeons and team surgery are not permitted.
CMS billing rules for 28496
- 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 procedure with modifier 50 is paid at 150%.
- 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 RVU2.42 · 15%
- Practice expense (office) RVU13.50 · 82%
- Malpractice RVU0.50 · 3%
81
Medicare services in 2024 · #5036 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.
28496 compared with similar codes
Office rates for Vermont, from the same CMS release.
$191.09
Use 28495 for closed treatment with manipulation but without skeletal fixation. Use 28496 when percutaneous fixation is added to the treatment.
$648.73
28505 describes open treatment of a great toe phalangeal fracture. Choose 28496 when the fracture is reduced and fixed percutaneously rather than treated through open exposure.
Compare 28496 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
Vermont →
Office / nonfacility
$535.68
Facility
$270.82
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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 28496 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
3,218
- Code
- 28496
- Physician work
- 2.42
- Practice expense
- 13.50
- Malpractice
- 0.50
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.42 | × 1.000 | 2.4200 |
| Practice expense | 13.50 | × 0.990 | 13.3650 |
| Malpractice | 0.50 | × 0.506 | 0.2530 |
| Total RVUs | 16.0380 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Vermont$535.68
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.42 | 1 |
| Practice expense | 13.5 | 0.99 |
| Malpractice | 0.5 | 0.506 |
(2.42 × 1 + 13.5 × 0.99 + 0.5 × 0.506) × $33.4009 = $535.68
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.42 | 1 |
| Practice expense | 5.49 | 0.99 |
| Malpractice | 0.5 | 0.506 |
(2.42 × 1 + 5.49 × 0.99 + 0.5 × 0.506) × $33.4009 = $270.82
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.
28496 billing questions
How does this differ from 28495?
28495 describes closed treatment with manipulation. Use 28496 when the great toe fracture is also treated with percutaneous skeletal fixation.
How does this differ from 28490?
28490 is closed treatment without manipulation. This code represents manipulation plus percutaneous skeletal fixation.
Can the fixation be reported separately from the fracture treatment?
Percutaneous skeletal fixation is part of the service represented by 28496. Do not report a separate fracture-treatment code for the same great toe fracture.
What should the operative note document?
Document the great toe fracture, manipulation or reduction, and the percutaneous skeletal fixation performed. The record should support that the treatment went beyond closed reduction alone.
How is bilateral treatment reported?
When both great toes are treated, report bilateral services with modifier 50. CMS pays bilateral reporting at 150%.
Does the code include related postoperative visits?
Yes. Its 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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.
3,21528485,,Optx metatarsal fx each,A,,7.25,7.96,NA,7.96,,1.02,16.23,16.23,0,090,0.10,0.69,0.21,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,21628490,,Treat big toe fracture,A,,1.14,3.44,,2.65,,0.17,4.75,3.96,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,21728495,,Treat big toe fracture,A,,1.64,4.02,,2.78,,0.20,5.86,4.62,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,21828496,,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
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
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817