How much does Medicare pay for CPT 28010?

Medicare allowed an average of $172.46 per service and paid $132.14 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $861.12, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 28010?

Repair of toe tendon. It was billed 5,031 times to 2,793 Medicare beneficiaries by 159 providers in 2024.

Does 28010 pay differently in an office than a hospital?

Yes. The allowed amount averaged $182.32 in an office setting and $118.90 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 28010 most?

Podiatry, with 4,575 services from 148 clinicians. Next are Orthopedic Surgery, Ambulatory Surgical Center.

CPT 28010

Repair of toe tendon

$172.46Medicare-allowed amount per service, averaged across 5,031 services

Providers submitted

$861.12

Asking price, not received

Medicare allowed

$172.46

The fee schedule figure

Medicare paid

$132.14

Balance is patient coinsurance

Providers submitted an average of $861.12 for this code and Medicare allowed $172.46 — 5.0× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $132.14 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $182.32
Hospital / facility: $118.90

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 4,249 services were billed in an office setting and 782 in a facility.

Services: 5,031
Beneficiaries: 2,793
Providers billing it: 159
Total allowed: $867,646

What Medicare pays for CPT 28010

Across 5,031 services billed by 159 providers to 2,793 beneficiaries, Medicare allowed an average of $172.46 per service. That is 1.8 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 28010

Specialty	Services	Beneficiaries	Avg allowed	Providers
Podiatry	4,575	2,593	$177.73	148
Orthopedic Surgery	307	131	$145.55	8
Ambulatory Surgical Center	149	69	$66.09	3

28010 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	367	$181.85	$128.35	10
South Carolina	301	$169.35	$133.45	9
Arizona	265	$174.57	$141.96	9
Florida	262	$201.44	$154.99	12
North Carolina	253	$180.44	$143.45	5
Texas	232	$194.07	$157.67	9
Tennessee	199	$153.46	$125.57	4
Washington	191	$180.39	$133.50	7
Kentucky	182	$161.52	$127.54	6
Illinois	178	$198.05	$154.50	7
Wisconsin	177	$100.29	$76.78	3
Oregon	171	$181.89	$131.56	6
Indiana	170	$182.14	$147.54	4
New York	166	$196.23	$143.27	6
Nebraska	149	$143.64	$117.96	2
Oklahoma	129	$184.95	$150.10	6
Alabama	128	$151.23	$120.71	2
Colorado	121	$110.98	$87.39	3
North Dakota	117	$124.75	$99.28	2
Mississippi	115	$161.24	$129.19	1
Virginia	113	$195.99	$145.30	5
Pennsylvania	111	$210.62	$151.60	4
Idaho	109	$159.07	$131.51	4
Kansas	90	$152.08	$128.96	4
Minnesota	69	$163.22	$124.63	2
Ohio	68	$204.46	$155.14	3
New Hampshire	68	$193.15	$136.14	2
Georgia	64	$178.33	$158.71	2
Iowa	61	$202.11	$166.64	4
Vermont	55	$153.28	$120.69	1
Missouri	54	$142.33	$117.13	2
Nevada	50	$86.85	$67.68	2
Louisiana	49	$183.03	$157.92	2
Utah	37	$179.84	$142.08	1
Maryland	30	$206.22	$150.65	1
Michigan	29	$218.76	$175.35	2
New Jersey	28	$175.97	$132.61	1
New Mexico	20	$170.60	$142.22	1
Arkansas	18	$169.51	$148.97	1
Massachusetts	18	$238.38	$152.87	1
Connecticut	17	$241.51	$167.71	1

Related codes

28001Drainage of fluid filled sac in foot$152.09
28011Repair of multiple toe tendons$242.02

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.