CPT 28825
Global 000 ActivePartial amputation of toe
CPT 28825 Billing & Documentation Guide
CPT code 28825 (Partial amputation of toe) is classified under Surgery (Musculoskeletal) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 3.32, a non-facility practice expense RVU of 4.97, and a malpractice RVU of 0.39, a total non-facility RVU of 8.68 and facility RVU of 4.68. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $297.55, though rates vary from $260.2 to $369.45 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 28825, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 28825 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 8 units of 28825 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 28825
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 3.32 | 3.32 |
| Practice Expense RVU | 4.97 | 0.97 |
| Malpractice RVU | 0.39 | 0.39 |
| Total RVU | 8.68 | 4.68 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 28825
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $318.36 | $160.27 | $301.7 - $369.45 | 29 |
| Florida | $302.8 | $168.75 | $289.17 - $316.64 | 3 |
| Georgia | $285.01 | $157.56 | $274.49 - $295.53 | 2 |
| Illinois | $296.57 | $167.48 | $282.81 - $308.4 | 4 |
| Michigan | $285.11 | $159.65 | $277.16 - $293.05 | 2 |
| North Carolina | $274.1 | $149.44 | $274.1 - $274.1 | 1 |
| New York | $319.05 | $170 | $277.75 - $339.55 | 5 |
| Ohio | $275.58 | $153.6 | $275.58 - $275.58 | 1 |
| Pennsylvania | $288.41 | $157.55 | $275.59 - $301.24 | 2 |
| Texas | $287.03 | $155.5 | $274.05 - $298.28 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 28825
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 28825 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 01470 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01995 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0490T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
Frequently Asked Questions, CPT 28825
What does CPT code 28825 mean? +
CPT code 28825 represents: Partial amputation of toe. It's in the Surgery (Musculoskeletal) category with a global period of 000.
What is the Medicare reimbursement for CPT 28825? +
The 2026 Medicare national average non-facility payment for CPT 28825 is $297.55. Rates range from $260.2 to $369.45 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 28825? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 28825? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 2, 2026.
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