Closed treatment of a great toe phalanx or phalanges fracture performed without any manual realignment of the bone fragments.

Verified May 8, 2026 · 6 sources ↓

Medicare: $158.65
Total RVUs: 4.75
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCTldsystemsFindacodeEmedny

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 6 cited references ↓

X-ray report confirming fracture location (proximal phalanx, distal phalanx, or both) and displacement status
Explicit statement that no manipulation was performed to reposition fracture fragments
Description of immobilization method applied — buddy taping, surgical shoe, splint, or walking boot
Laterality documented (left vs. right great toe) to support LT/RT modifier usage
Weight-bearing restrictions and follow-up plan documented in the encounter note
ICD-10 fracture code capturing laterality and encounter type (initial: 7th character A; subsequent: D or G)

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 28490 covers non-manipulative, closed management of a fracture involving the proximal or distal phalanx — or both — of the great toe. Treatment typically involves immobilization via buddy taping, a surgical shoe, or splinting, combined with weight-bearing restrictions. Because the code descriptor reads 'phalanx or phalanges,' it covers both phalanges of the hallux under a single unit of service — billing 28490 twice for a same-foot, same-encounter dual-phalanx fracture is not supported.

The 90-day global period means all routine follow-up visits, dressing changes, and fracture monitoring through day 90 are bundled into this code. Any E/M service billed during that window for a reason unrelated to the fracture requires modifier 24. If a new, unrelated surgical procedure is performed during the global, append modifier 79. The initial E/M visit at which fracture care is first rendered and the decision to treat is made can be billed separately with modifier 57 if the fracture code carries a 90-day global.

When the fracture requires manipulation, step up to 28495 (closed with manipulation) or 28496 (percutaneous pinning). Open treatment is coded to 28505. Do not confuse 28490 with 28510, which covers closed non-manipulative fractures of the lesser toes (digits 2–5), each reported separately.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	1.14
Practice expense RVU	3.44
Malpractice RVU	0.17
Total RVU	4.75
Medicare national rate	$158.65
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$158.65
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI P3) Ambulatory surgical center (freestanding)	$115.47

Common denial reasons

The recurring reasons claims for CPT 28490 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Billing 28490 twice for dual-phalanx fractures of the same great toe — the descriptor covers phalanx or phalanges as a single service
Using 28490 for a lesser toe (digits 2–5) fracture instead of the correct code 28510
Billing an E/M service during the 90-day global period without modifier 24 when the visit is unrelated to the fracture
Missing laterality modifier (LT or RT) causing payer rejection or request for additional documentation
Selecting 28490 when operative note documents manipulation — that maps to 28495 or 28496, not 28490

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Can I bill 28490 twice when both the proximal and distal phalanges of the great toe are fractured?

No. The code descriptor says 'phalanx or phalanges' — it intentionally covers one or both phalanges of the hallux in a single unit of service. Billing two units for the same great toe on the same date will be denied.

02What modifier do I use to distinguish left vs. right great toe?

Use LT for the left great toe and RT for the right. Many payers require these for toe-level fracture codes, and missing them is a common clean-claim failure.

03Can I bill an E/M visit at the same encounter when I first decide to apply fracture care?

Yes. When the decision for fracture management is made during the same visit, bill the E/M with modifier 57 (decision for surgery) alongside 28490. Routine follow-up E/M visits within the 90-day global are bundled unless unrelated — those need modifier 24.

04The patient's fracture was non-displaced but I placed them in a surgical shoe and taped the toe — does that still qualify as 28490?

Yes, as long as no manipulation occurred. Immobilization without repositioning is the defining feature of 28490. Document the specific immobilization method used.

05How does 28490 differ from 28510?

28490 is exclusively for the great toe (hallux). 28510 covers closed, non-manipulative fractures of the lesser toes (digits 2–5) and is billed per toe. Using 28510 for a hallux fracture is an incorrect code selection that will likely survive initial claim scrubbing but fail on audit.

06If the fracture displaces during follow-up and manipulation becomes necessary, what code applies?

Manipulation performed during a subsequent visit within the global period maps to 28495. Append modifier 58 (staged or related procedure during the postoperative period) to signal that this is a planned escalation of care, not a repeat of the original service.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the fracture site (proximal phalanx, distal phalanx, or both), confirms no manipulation was performed, records the immobilization method applied, and flags laterality for LT/RT modifier assignment — all from dictation. This prevents the most common 28490 audit trigger: operative notes that fail to explicitly state absence of manipulation, which reviewers use to question whether 28495 should have been billed instead.

See how Mira captures CPT 28490 documentation