Closed treatment of a phalangeal fracture of any toe except the great toe, without manipulation, billed per toe treated.

Verified May 8, 2026 · 6 sources ↓

Medicare: $130.93
Work RVU: 1.14
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCTldsystemsPodiatrymMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Radiographic confirmation of fracture with fragment position described as acceptable
Specify which toe(s) are fractured — digit number and laterality (left vs. right foot)
Document the stabilization method applied (splint, brace, cast, surgical shoe, or buddy taping with rationale)
Confirm fracture involves phalanx or phalanges of lesser toe(s), not the great toe
If billing multiple units, document separate clinical justification for each toe treated independently
For same-day E/M, document that the E/M service was significant and separately identifiable from the fracture care

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 28510 covers closed, non-manipulative fracture care of the lesser toes (digits 2–5). It does not apply to the great toe — use 28490 for hallux fractures. The code carries a 90-day global period, which bundles all routine post-fracture follow-up through day 90 into the initial fracture care payment. Any unrelated E/M visit during that window needs modifier 79 on the procedure or modifier 24 on the E/M.

The MUE for 28510 is 4, meaning it can be billed up to four units on a single date of service. However, when multiple fractured lesser toes on the same foot are treated simultaneously — buddy taping, surgical shoe, CAM boot — the treatment is functionally one intervention. Bill one unit in that scenario, not one per toe. If toes on both feet are treated on the same date, LT/RT modifiers distinguish laterality.

Buddy taping alone is a gray area: the procedure description references application of a splint, brace, or cast. Many payers expect some immobilization device beyond buddy tape to support 28510. Document whatever stabilization method was applied. Radiographic confirmation of fracture with fragments in acceptable position should be explicitly noted in the record.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (1.14) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (3.92) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.14
Practice expense RVU	2.63
Malpractice RVU	0.15
Total RVU	3.92
Medicare national rate	$130.93
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	$130.93
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI P3) Ambulatory surgical center (freestanding)	$88.28

Common denial reasons

The recurring reasons claims for CPT 28510 get rejected.

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

Code billed for great toe fracture — 28510 excludes the hallux; use 28490 instead
Multiple units billed when all fractured toes on the same foot were treated with a single intervention
E/M denied as bundled into fracture care global on the same date without modifier 25
Insufficient documentation of stabilization — no splint, brace, or cast noted to support fracture care code over E/M-only billing
Laterality modifier missing when bilateral lesser toe fractures treated on the same date of service

Frequently asked questions

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

01Can I bill 28510 for a great toe fracture?

No. CPT 28510 explicitly excludes the great toe. Use 28490 for closed treatment of a hallux fracture without manipulation.

02If I treat three fractured lesser toes on the same foot in one visit, how many units of 28510 do I bill?

Bill one unit. When the treatment — buddy taping, surgical shoe, CAM boot — addresses all fractured toes simultaneously, there is no separate intervention per toe. The MUE of 4 is a ceiling, not an entitlement.

03Does buddy taping alone support billing 28510?

It's contested. The procedure description references a splint, brace, or cast. Buddy taping without any additional immobilization device puts the claim at risk with many payers. Document the clinical rationale thoroughly if buddy taping is the sole intervention.

04Can I bill an E/M on the same day as 28510?

Yes, if the E/M is significant and separately identifiable from the fracture care decision. Append modifier 25 to the E/M. If the E/M was the decision point for initiating fracture care as a surgical service, modifier 57 applies instead — though with a 90-day global, that distinction matters for your records.

05How does the 90-day global period affect follow-up billing for 28510?

All routine post-fracture follow-up visits through day 90 are bundled into the 28510 payment. To bill a separate E/M within the global for an unrelated problem, append modifier 24 to the E/M and document that the visit addressed a condition unrelated to the toe fracture.

06What modifiers are needed when treating fractured lesser toes on both feet on the same date?

Use LT and RT to distinguish laterality. If the same toe (e.g., the second digit) is fractured bilaterally, LT and RT on separate line items is cleaner than modifier 50 for most payers — confirm with your specific payer policies.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the fracture digit number, laterality, radiographic findings, fragment position, and the specific stabilization method applied from dictation. This prevents the two most common audit flags: missing laterality and undocumented treatment type that reviewers use to downcode fracture care to an E/M-only visit.

See how Mira captures CPT 28510 documentation