Billing code 28092: Toe lesion excisionMedicare rate & RVUs in Washington
Excision of a localized toe lesion involving tendon or joint capsule, reported when the operative work removes that structure rather than a size-defined soft-tissue tumor.
Medicare pays $436.18–$491.28 for 28092 in the office in Washington, from Rest Of Washington to Seattle (King Cnty). 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 28092 covers
This procedure removes a localized lesion involving a toe tendon or joint capsule. Podiatrists and orthopedic foot-and-ankle surgeons commonly perform it for a symptomatic lesion requiring operative excision, in an office procedure setting or operating room depending on the case. The operative note should identify the toe, lesion, involved structure, and extent of removal.
Report the service when the excised lesion and operative anatomy support this tendon-or-capsule procedure, rather than a soft-tissue tumor code selected by depth and size. 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 multiple-procedure reduction. Do not report modifier 50 for this service. Medicare does not pay an assistant at surgery, and 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.
Where 28092 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | $436.18 | $265.95 |
| Seattle (King Cnty) | $491.28 | $292.92 |
How the 28092 rate is calculated
Each of 28092’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 · 28092
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 3.69Practice expense 8.57Malpractice 0.39
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 28092
28092 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 28092
Toe lesion excision
| 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) | 1 | Not paid (statutory restriction). |
| 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 · 28092
Toe lesion excision
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
28092 without 51 · national office
$422.52
Toe lesion excision
28092-51 · Second procedure: 50%
$211.26
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%).
28092 compared with similar codes
Compare codes
28092 vs 28090 vs 28043 vs 28045: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 28090Foot lesion excision
- Choose 28092 for a toe lesion involving tendon or capsule; 28090 is the related service for a lesion involving the foot.
- 28043Tumor excision
- 28043 describes excision of a qualifying superficial soft-tissue tumor under the applicable size threshold. Use 28092 when the operative target is a toe lesion involving tendon or capsule.
- 28045Foot mass excision
- 28045 describes excision of a qualifying deep soft-tissue tumor under the applicable size threshold. This code instead identifies a toe lesion involving tendon or capsule.
28092 billing questions
How does this differ from 28090?
28092 is for a lesion involving a toe tendon or capsule; 28090 is the corresponding excision service for the foot. Document the actual site and structure treated.
When should a soft-tissue tumor code be considered instead?
Consider codes such as 28043 or 28045 when the service is excision of a soft-tissue tumor and the applicable depth and size criteria support that code. This code describes a lesion involving toe tendon or capsule.
Is modifier 50 appropriate for both toes?
No. CMS identifies bilateral adjustment as inappropriate for this descriptor or anatomy; do not append modifier 50.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.
How are other procedures paid when performed in the same session?
The highest-valued procedure is paid in full, and 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 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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