$572.30–$666.15
This code concerns a metatarsal osteotomy. Choose sesamoid removal when the operative target is the sesamoid bone rather than a metatarsal cut or realignment.
On this page
CMS RVU26D · Effective 2026-10-01
28315 Sesamoidectomy Medicare reimbursement rates in Virginia
Reports surgical removal of a symptomatic foot sesamoid, commonly beneath the great toe, for persistent pain from sesamoid disease or injury. Compare 28315 office and facility rates across CMS payment localities in Virginia.
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 28315 in Virginia?
Virginia has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$470.90–$545.60
2 of 2 localities have a supported rate.
Facility setting
$303.45–$344.93
2 of 2 localities have a supported rate.
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.
Foot surgery
About 28315: Foot sesamoid bone removal
Reports surgical removal of a symptomatic foot sesamoid, commonly beneath the great toe, for persistent pain from sesamoid disease or injury.
This procedure removes a sesamoid bone in the foot, most often one of the small bones beneath the first metatarsal head at the great toe. Podiatrists and orthopedic surgeons may perform it for persistent focal pain associated with sesamoiditis, fracture, nonunion, or avascular change when surgery is chosen. The work may take place in an operating room or an appropriately equipped outpatient surgical setting.
Report the procedure for removal of the sesamoid itself, not an osteotomy of a metatarsal or correction of a toe deformity alone. The operative report should identify the treated foot and sesamoid, the indication, and the removal performed. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 bilateral procedures are paid at 150%. Assistant-at-surgery payment is restricted; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 28315
- 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 paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU4.88 · 34%
- Practice expense (office) RVU8.99 · 62%
- Malpractice RVU0.54 · 4%
2.1K
Medicare services in 2024 · #2424 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.
28315 compared with similar codes
Office rates for Virginia, from the same CMS release.
$464.65–$537.48
This code describes partial excision of a toe phalanx. It is not the code for removal of a sesamoid beneath the great toe.
$865.41–$1,005.63
This code describes hallux valgus correction with a distal metatarsal osteotomy. Sesamoid removal alone does not represent that deformity-correction procedure.
Compare 28315 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.
2 of 2 payment localities
Dc + Md/Va Suburbs →
Office / nonfacility
$545.60
Facility
$344.93
Virginia →
Office / nonfacility
$470.90
Facility
$303.45
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28315 billing questions
When is this code appropriate instead of a metatarsal osteotomy code?
Use this code when the surgeon removes a foot sesamoid. A metatarsal osteotomy code describes cutting or realigning a metatarsal, not removing the sesamoid.
Does the global period include related postoperative care?
Yes. CMS assigns a 90-day global period that includes the day-before preoperative visit and 90 days of related postoperative care.
How is bilateral sesamoid removal handled?
CMS identifies the procedure as bilateral-eligible with modifier 50; the bilateral procedure is paid at 150%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment is restricted by statute. Co-surgeons are paid only when supporting documentation is provided; team surgery is not permitted.
What happens when another procedure is performed in the same session?
CMS pays the highest-valued procedure in full and applies the standard multiple procedure reduction to the others. Document the distinct work performed for each reported procedure.
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.
3,18728310,,Revision of big toe,A,,5.43,10.82,,4.37,,0.67,16.92,10.47,0,090,0.10,0.69,0.21,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,18828312,,Revision of toe,A,,4.57,12.55,,5.09,,0.72,17.84,10.38,0,090,0.10,0.69,0.21,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,18928313,,Repair deformity of toe,A,,5.02,10.62,,4.66,,0.70,16.34,10.38,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,19028315,,Removal of sesamoid bone,A,,4.88,8.99,,3.89,,0.54,14.41,9.31,0,090,0.10,0.69,0.21,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,19128320,,Repair of foot bones,A,,9.14,6.77,NA,6.77,,1.39,17.30,17.30,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,19228322,,Repair of metatarsals,A,,8.32,14.74,,6.55,,1.31,24.37,16.18,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,19328340,,Resect enlarged toe tissue,A,,6.97,9.12,,3.84,,0.59,16.68,11.40,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00