CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 28531 RVU and Medicare Payment (2026)
Treat sesamoid bone fracture — 2.51 work RVU, about $323.32 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 2.51
- PE RVU (non-facility)
- 6.96
- PE RVU (facility)
- 2.51
- MP RVU
- 0.21
- Office payment
- $323.32
- Facility payment
- $174.69
How the payment is calculated
Total RVU is work plus practice expense plus malpractice, each adjusted by its GPCI factor, then multiplied by the conversion factor. For 28531 in a non-facility setting with national GPCI: (2.51 + 6.96 + 0.21) × $33.4009 ≈ $323.32. The same code in a facility setting pays about $174.69 because facility PE RVU (2.51) replaces office PE RVU.
What changes by locality
GPCI moves 28531 non-facility payment from $287.14 to $432.04 across CMS localities — from Arkansas to San Jose-sunnyvale-santa Clara (san Benito Cnty). Check your exact locality in the GPCI calculator rather than using a state average.
Related codes
Checking a different code or locality? Open the full RVU calculator to run any of the 7,790 CPT/HCPCS codes with your own GPCI factors.
Frequently asked questions
What is the 2026 work RVU for CPT 28531?
2.51. Work RVU measures physician time, skill, and intensity — it does not change by setting or locality. Total payment adds practice expense and malpractice RVUs plus the conversion factor.
How much does Medicare pay for CPT 28531 in 2026?
About $323.32 non-facility ($174.69 facility) at national GPCI with the 2026 $33.4009 conversion factor. Your locality GPCI moves the number — see the range above.
Does the work RVU change between office and facility?
No. Work RVU (2.51) and malpractice RVU stay fixed; only practice expense changes (6.96 office vs 2.51 facility). That is the entire office-vs-facility payment gap.