$165.25
Both address toe interphalangeal joint dislocations. Choose 28630 when reduction is performed without anesthesia; 28635 is for manipulation requiring anesthesia.
On this page
CMS RVU26D · Effective 2026-10-01
28630 Toe dislocation Medicare reimbursement rates in Wisconsin
Reports closed reduction of a single toe interphalangeal joint dislocation when the provider restores alignment without anesthesia. Compare 28630 office and facility rates across CMS payment localities in Wisconsin.
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 28630 in Wisconsin?
Wisconsin 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
$160.57
1 of 1 localities have a supported rate.
Payment area: Wisconsin
One mapped payment locality.
Facility setting
$102.34
1 of 1 localities have a supported rate.
Payment area: Wisconsin
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 procedure
About 28630: Closed reduction of toe interphalangeal dislocation
Reports closed reduction of a single toe interphalangeal joint dislocation when the provider restores alignment without anesthesia.
This service is the closed reduction of a dislocated toe interphalangeal joint, such as a proximal or distal joint, without anesthesia. An orthopedic surgeon, podiatrist, or other qualified clinician may perform the reduction in an office, emergency department, or other acute-care setting. The joint is realigned without opening the site; open repair is a different service. The code is for one interphalangeal joint, not a metatarsophalangeal joint or a foot-joint dislocation.
Document the affected toe and joint, the dislocation, and the closed reduction performed without anesthesia. Related postoperative visits during the 10-day global period are included. When multiple procedures are performed in the same session, Medicare pays the highest-valued procedure in full and reduces the others by 50%. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 28630
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days 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 adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.71 · 33%
- Practice expense (office) RVU3.14 · 61%
- Malpractice RVU0.29 · 6%
181
Medicare services in 2024 · #4417 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.
28630 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
$363.23
This code concerns a toe metatarsophalangeal joint dislocation. Choose 28630 when the dislocated joint is interphalangeal.
$555.66
This code is for open treatment of an interphalangeal joint dislocation. 28630 describes closed reduction without anesthesia.
Compare 28630 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
Wisconsin →
Office / nonfacility
$160.57
Facility
$102.34
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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 28630 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
3,237
- Code
- 28630
- Physician work
- 1.71
- Practice expense
- 3.14
- Malpractice
- 0.29
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.71 | × 1.000 | 1.7100 |
| Practice expense | 3.14 | × 0.958 | 3.0081 |
| Malpractice | 0.29 | × 0.308 | 0.0893 |
| Total RVUs | 4.8074 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Wisconsin$160.57
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.71 | 1 |
| Practice expense | 3.14 | 0.958 |
| Malpractice | 0.29 | 0.308 |
(1.71 × 1 + 3.14 × 0.958 + 0.29 × 0.308) × $33.4009 = $160.57
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.71 | 1 |
| Practice expense | 1.32 | 0.958 |
| Malpractice | 0.29 | 0.308 |
(1.71 × 1 + 1.32 × 0.958 + 0.29 × 0.308) × $33.4009 = $102.34
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.
28630 billing questions
When should 28630 be chosen instead of 28635?
Use 28630 for closed reduction of a toe interphalangeal joint dislocation without anesthesia. The related 28635 code is for treatment involving manipulation that requires anesthesia.
Does this code cover an MTP joint dislocation?
No. This code is for an interphalangeal joint in a toe. A metatarsophalangeal joint dislocation is represented by a different code.
Can modifier 50 be reported for both feet?
No. CMS identifies bilateral adjustment as inappropriate for this code. The descriptor or anatomy does not support modifier 50.
What documentation supports reporting 28630?
Record the dislocated toe interphalangeal joint and the closed reduction performed without anesthesia. The documentation should distinguish this service from an MTP joint reduction or open repair.
Are follow-up visits included?
Related postoperative visits for 10 days are included in the global period.
How does Medicare handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures are reduced by 50%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
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.
3,23428605,,Treat foot dislocation,A,,2.82,8.08,,5.94,,0.59,11.49,9.35,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,23528606,,Treat foot dislocation,A,,4.96,5.71,NA,5.71,,0.92,11.59,11.59,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,23628615,,Repair foot dislocation,A,,10.43,11.48,NA,11.48,,1.84,23.75,23.75,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,23728630,,Treat toe dislocation,A,,1.71,3.14,,1.32,,0.29,5.14,3.32,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,23828635,,Treat toe dislocation,A,,1.91,3.10,,1.55,,0.22,5.23,3.68,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,23928636,,Treat toe dislocation,A,,2.70,8.35,,3.24,,0.57,11.62,6.51,0,010,0.10,0.80,0.10,2,0,1,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,24028645,,Repair toe dislocation,A,,7.25,11.80,,5.66,,0.90,19.95,13.81,0,090,0.10,0.69,0.21,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,