# Bunion Surgery: Cost, Coverage, and What to Expect

Source: https://ourhealthnetwork.com/procedure-costs/bunion-surgery
Last reviewed: 2026-04-20
Data: CMS Hospital and Outpatient pricing, CPT/HCPCS code mapping

## Quick answer

Medicare pays about $1,387 to the surgeon for a big toe joint fusion. The complete bill including facility, anesthesia, and hardware runs $7,000 to $15,000 on commercial insurance, with the surgical setting driving most of the price difference.

## What it is

Big toe joint fusion, clinically called first metatarsophalangeal (MTP) arthrodesis, permanently joins the two bones that meet at the base of your big toe. Surgeons remove the damaged cartilage, position the bones in a corrected alignment, and hold them together with screws, a plate, or both until the bones grow into one solid unit. Once fused, the joint no longer bends, but it also no longer hurts or drifts sideways.

This surgery is one of several procedures used for severe bunions or end-stage big toe arthritis (hallux rigidus). It's different from a standard bunionectomy, which reshapes bone and soft tissue but keeps the joint mobile. Fusion is more definitive and is generally reserved for severe cases where the joint is too damaged or deformed for a joint-preserving repair.

- **Surgery time:** 60 to 90 minutes in the operating room
- **Anesthesia:** usually regional block at the ankle plus light sedation, or general anesthesia if you prefer
- **Setting:** almost always outpatient; you go home the same day
- **Incision:** one 2-to-4-inch cut on top of the foot near the big toe
- **Hardware:** one or two screws, sometimes with a small titanium plate, left in permanently unless they cause irritation later
- **Weight-bearing:** you'll wear a surgical shoe or boot and keep weight off the toe for 4 to 6 weeks

Medicare data shows a single HCPCS code covers this procedure (28750). That means there isn't a cheaper or more expensive variant to choose between once your surgeon has decided fusion is the right fix. The cost conversation is really about setting, hardware, and insurance.

## When it is done

Fusion isn't the first option for most foot problems. Surgeons typically recommend it only after a careful look at how damaged your joint is and whether less drastic fixes would hold up.

Alternatives tried first include a standard bunionectomy (milder bunions with healthy cartilage), a cheilectomy (shaving bone spurs while keeping the joint), or a joint replacement with an implant. Fusion is chosen when those won't solve the problem or are likely to fail.

Your doctor may recommend big toe joint fusion when:

1. You have severe hallux rigidus (advanced big toe arthritis) with bone-on-bone grinding and lost cartilage
2. You have a severe bunion that has caused the joint to deteriorate, not just drift sideways
3. Previous bunion or joint surgery failed and the joint is now unstable or painfully arthritic
4. You have a neuromuscular condition like rheumatoid arthritis that has destroyed the joint
5. Conservative care (orthotics, wider shoes, injections, stiff-soled rocker shoes) has stopped working
6. The deformity is bad enough that you can't comfortably wear normal shoes or walk without pain

People who do very high-impact activities or need full big toe bend (competitive runners, certain dancers) are sometimes steered toward joint-preserving procedures instead, since fusion permanently eliminates the bend. For most patients, though, the trade-off is worth it: a stiff but painless toe beats a mobile but miserable one.

## What you pay

The Medicare number in our hero stat ($1,387) is the national average the surgeon gets paid for this operation. It does not include the facility fee, anesthesia, hardware, or any pre-op imaging. Once you add those, the total bill that hits your insurance is several times larger. Commercial insurance pays roughly 2x to 3x what Medicare pays for the same services, which is why the sticker on this surgery varies so much.

**If you're on Medicare:**

- Part B covers the surgery as outpatient. You'll owe the Part B deductible ($257 in 2025) if you haven't already met it, then 20% coinsurance on the Medicare-allowed amount.
- On the surgeon fee alone, 20% of $1,387 is roughly $277 out-of-pocket.
- The facility charge (ambulatory surgery center or hospital outpatient) is billed separately. ASC facility fees run Medicare about $1,200 to $1,800; hospital outpatient fees are higher.
- A Medigap or Medicare Advantage plan usually covers some or all of the 20% coinsurance, but Advantage plans may require prior authorization.

**If you have commercial insurance:**

- Expect the full bill (surgeon, facility, anesthesia, hardware) to land between $7,000 and $15,000 before insurance discounts.
- After network discounts, the insurer-allowed amount is $5,500 to $10,000. Your share depends on where you are in your deductible and out-of-pocket maximum.
- A typical patient with a $2,000 deductible and 20% coinsurance pays $1,500 to $4,000 out-of-pocket. Hitting your plan's out-of-pocket max caps further spending.
- Prior authorization is almost always required. Make sure your surgeon's office submits it before scheduling.

**If you're uninsured or paying cash:**

- Ambulatory surgery centers often offer a bundled cash-pay rate of $5,500 to $9,500 that combines surgeon, facility, anesthesia, and hardware into one price.
- Hospital cash prices for the same procedure frequently run $12,000 to $25,000 unless you negotiate.
- Most hospitals have financial-assistance or charity-care programs that can cut the bill by 30% to 80% if your income is under a certain threshold. Ask before scheduling, not after.
- Paying the bundled ASC rate up front is almost always cheaper than a payment plan on an itemized hospital bill.

## Anatomy of the bill

Big toe joint fusion usually generates four or five separate bills, often from four different billing parties.

**Surgeon fee:** The operating surgeon bills for the procedure itself, including standard follow-up visits in the first 90 days. Medicare averages about $1,387 here; commercial rates are $2,500 to $4,500.

**Facility fee:** The ambulatory surgery center or hospital outpatient department bills for the operating room, nursing, supplies, and recovery. This is often the single largest line item. ASCs run $1,500 to $3,500 on commercial insurance; hospital outpatient departments run $3,500 to $7,500 for the same service.

**Anesthesia:** A separate anesthesiologist or CRNA bills for the block and sedation. Typical commercial charges run $600 to $1,500 depending on case length.

**Hardware and implants:** Screws and plates are often billed through the facility, but occasionally itemized. Titanium screws run $100 to $400 each; a small plate with screws can add $800 to $2,000 to the bill.

**Pre-op visits and imaging:** X-rays, a surgical consult, and possibly a cardiac clearance for older patients. Expect $300 to $800 added, depending on what's ordered.

**Post-op physical therapy:** Usually not required for fusion the way it is for total knee or hip replacement, but some surgeons prescribe 4 to 8 sessions for gait training after the boot comes off. Figure $75 to $150 per session on commercial insurance.

**Pathology:** Rare for this surgery, but if the surgeon removes a bone spur or sends tissue to the lab, a separate pathology bill ($150 to $400) may appear.

## Cost by state

State-level Medicare data for this procedure shows the surgeon fee alone ranges from about $203 in Utah to $486 in New Jersey. These state numbers are the physician portion only, not the full bill; they understate total cost but are still useful for relative comparison.

Virginia has the highest volume (929 services), followed by Florida (651), North Carolina (645), and Iowa (544). High-volume states typically have more surgeons competing for cases, which can modestly soften prices on the commercial side. Commercial insurance pricing varies much more dramatically than Medicare because it's negotiated hospital by hospital.

**Why costs vary so much by state:**

- **Medicare GPCI adjustments:** Medicare applies a Geographic Practice Cost Index that raises payments in high-cost metro areas and cuts them in lower-cost regions. The same surgery can pay 40% more in coastal California than rural Utah.
- **Commercial negotiation leverage:** In states dominated by one or two health systems, hospitals negotiate higher rates with insurers because there's nowhere else to send patients.
- **State balance-billing laws:** Some states have stronger protections against out-of-network anesthesiologist and assistant surgeon bills than federal law alone provides.
- **Cost of living and overhead:** Facility fees scale with local wages, real estate, and malpractice costs.

## Office vs facility

Big toe joint fusion is almost never done in an office setting. Medicare data shows 5,109 services performed in a facility (ambulatory surgery center or hospital outpatient) versus only 72 in office-based settings. The office number reflects unusual cases, not a real patient choice. So the real decision isn't office vs facility; it's ambulatory surgery center (ASC) vs hospital outpatient department (HOPD).

The cost difference between those two settings is often the single biggest dollar swing on the entire bill. ASCs charge 30% to 50% less than hospital outpatient departments for the identical surgery, and they're just as safe for this type of case.

**When a hospital outpatient department makes more sense:**

- You have significant heart, lung, or kidney disease that warrants hospital-level backup
- You need specialized anesthesia the ASC can't provide
- Your surgeon only operates at the hospital and has strong volume there

**When an ambulatory surgery center usually wins:**

- You're otherwise healthy and this is an elective outpatient case
- You're paying cash or have a high-deductible plan (the savings are substantial)
- You want a faster check-in, same-day discharge, and less exposure to hospital-acquired issues

## Who performs the procedure

Two specialties dominate big toe joint fusion: orthopedic surgeons and podiatrists. Medicare data shows 115 orthopedic surgeons performed about 4,947 of these procedures (roughly 62% of volume), while 81 podiatrists performed about 3,069 (roughly 38%). Both are fully qualified for this surgery; the choice often comes down to training focus and local availability.

Orthopedic surgeons who do a lot of foot and ankle work have completed a foot-and-ankle fellowship after their 5-year orthopedic residency. Podiatrists (DPMs) train 4 years in podiatric medical school plus a 3-year surgical residency focused entirely on the foot and ankle. For a relatively straightforward big toe fusion, outcomes between the two specialties are comparable when the surgeon has experience.

**What to look for when choosing a specialist:**

- **Case volume:** Surgeons who do 20 or more of these per year have markedly better outcomes than occasional performers. Ask directly: "How many fusions do you do in a year?"
- **Subspecialty focus:** For an orthopedic surgeon, look for foot-and-ankle fellowship training. For a podiatrist, look for a surgical residency (PMSR-36 or with added RRA credential).
- **Board certification:** American Board of Orthopaedic Surgery with foot-and-ankle subspecialty, or American Board of Foot and Ankle Surgery (ABFAS) for podiatrists.
- **Hospital privileges:** A surgeon who holds privileges at a respected hospital has passed that hospital's credentialing review, which is a useful secondary check.
- **Second opinion threshold:** If a surgeon recommends fusion on a first visit without discussing joint-preserving alternatives, get another opinion.
- **Revision rates:** Ask what they do when a fusion fails to heal (nonunion). Experienced surgeons have a clear answer.

## How to shop for the best price

The sticker price on this surgery is negotiable more often than patients realize.

1. **Get a Good Faith Estimate in writing.** Federal law (No Surprises Act, 2022) requires the facility to provide a written estimate within 3 business days of scheduling, and sooner if you ask. If the final bill exceeds the estimate by $400 or more, you can dispute it through cms.gov/nosurprises.
2. **Verify every billing party is in-network.** Surgeon, facility, anesthesia, and any assistant surgeon all bill separately. An in-network surgeon at an in-network facility can still use an out-of-network anesthesiologist. Get each party confirmed individually.
3. **Compare hospital vs ambulatory surgery center pricing.** For healthy patients, an ASC is often 30% to 50% cheaper. Ask your surgeon if they operate at both; if yes, compare estimates from each site.
4. **Ask about bundled cash-pay rates.** ASCs frequently offer bundled self-pay prices that include surgeon, facility, anesthesia, and hardware in one payment. For uninsured or high-deductible patients, the bundle often beats running the bill through insurance.
5. **Investigate financial assistance before you schedule.** Nonprofit hospitals are legally required to have charity-care policies. Many cover patients earning up to 200% or 300% of the federal poverty level. Ask for the written policy.
6. **Confirm the hardware.** Ask what screws and plates your surgeon uses and whether a standard-priced option is available. Premium titanium implants can add $1,000 to $2,000 to the bill without better outcomes for most patients.
7. **Get a second opinion on joint-preserving alternatives.** Fusion is permanent. If you haven't tried or seriously discussed a cheilectomy, injection, or implant, a second opinion may save you from unnecessary surgery or steer you toward a less expensive option.

Red flags when you're shopping include a facility that refuses a written estimate or a surgeon who can't give you a total ballpark. Also watch for a front desk that says it can't predict your share, or pressure to schedule before you've verified network status. None of these are reasons to trust the billing will work out.

## Surprise billing risks

Foot surgery bills blow up in predictable places. The most common problem isn't the surgeon; it's the ancillary providers who bill independently and may not be in your network even when the hospital is.

**Most common surprise-billing sources for this procedure:**

- **Anesthesiologists** who aren't part of the hospital's in-network group. This is the #1 surprise bill source in outpatient surgery nationwide.
- **Assistant surgeons** (especially at teaching hospitals) billing separately at out-of-network rates.
- **Hardware markups.** Some facilities pass through screw and plate costs at 3x to 5x their acquisition price. Commercial insurance usually pushes back, but uninsured patients pay sticker.
- **Pathology** if any bone or soft tissue is sent to an outside lab that isn't in your network.
- **Post-op durable medical equipment.** A surgical boot or knee scooter rented from an out-of-network supplier can bill hundreds more than the same equipment from a network supplier.

**If you get a surprise bill:**

- **Don't pay yet.** Request a fully itemized bill with CPT codes, and match each line to your insurer's explanation of benefits (EOB).
- **File a No Surprises Act dispute.** The 2022 federal law protects you from out-of-network emergency and ancillary charges at in-network facilities. File through cms.gov/nosurprises.
- **Contact your state insurance commissioner** if the facility or provider won't correct a clear balance-billing error. Many states have stronger protections than federal law.
- **Negotiate directly.** Even legitimate bills are often negotiable. Ask for the Medicare rate or a cash-pay discount; many providers will accept 40% to 60% of the billed charge rather than send the bill to collections.

## Total recovery cost

Recovery from big toe joint fusion takes longer than many patients expect. You'll be in a surgical shoe or walking boot for about 6 weeks while the bones fuse, with limited weight-bearing for the first 2 to 4 weeks. Most desk workers return to work in 1 to 2 weeks (with foot elevation); jobs that require standing or walking all day usually need 6 to 10 weeks off. Driving resumes when you're out of the boot (if right foot) or sooner (if left foot and automatic transmission). Full bone fusion takes 3 to 6 months, though pain typically resolves much earlier.

**Add-on costs to budget for:**

- **Surgical boot or walking cast:** $75 to $200 if your insurance doesn't cover the full cost
- **Knee scooter or crutches:** $50 to $150 to rent or buy for the first few weeks
- **Post-op X-rays:** 2 to 3 follow-up X-rays over 3 months, $75 to $200 each on commercial insurance
- **Physical therapy (if prescribed):** $75 to $150 per session × 4 to 8 sessions; usually covered by insurance minus your copay
- **Pain medication:** generic prescriptions $10 to $50 total
- **Time off work:** often the biggest real-world cost. 1 to 10 weeks of lost wages or PTO, depending on your job
- **Shoe modifications or new shoes:** many patients need wider or stiffer shoes after recovery, $100 to $300

The realistic total episode cost is usually 15% to 25% more than the procedure sticker price once you add imaging, equipment, PT, and medications. On commercial insurance, a $10,000 procedure becomes an $11,500 to $12,500 total episode by the time you're fully back on your feet. Lost wages can easily double that for patients whose jobs require standing.

## Variants of this procedure

- Big Toe Joint Fusion

## Frequently asked questions

### How much does bunion surgery cost with insurance?

On commercial insurance, the full bill runs $7,000 to $15,000 before network discounts, and patient out-of-pocket usually lands between $1,500 and $4,000 depending on your deductible and coinsurance. If you've already met your out-of-pocket max for the year, you may owe little or nothing. If you haven't met your deductible, expect to pay more.

### Does Medicare cover big toe joint fusion?

Yes. Medicare Part B covers this as an outpatient surgery when it's medically necessary. You'll owe the Part B deductible ($257 in 2025) plus 20% coinsurance on the Medicare-allowed amount, unless you have a Medigap or Medicare Advantage plan that covers that cost-sharing. Prior authorization is sometimes required by Advantage plans.

### How long is recovery after big toe joint fusion?

You'll be in a surgical boot for about 6 weeks and off your feet or on limited weight-bearing for the first 2 to 4 weeks. Desk workers usually return in 1 to 2 weeks; jobs that require standing need 6 to 10 weeks. Complete bone fusion takes 3 to 6 months, though most patients feel substantially better well before then.

### Is bunion surgery outpatient or does it require a hospital stay?

Almost always outpatient. Medicare data shows the surgery is performed in a facility setting in more than 98% of cases, and nearly all of those patients go home the same day. An overnight stay is unusual and only happens for patients with significant medical conditions that warrant closer monitoring.

### How do I avoid a surprise bill?

Before surgery, confirm in writing that the surgeon, facility, anesthesiologist, and any assistant surgeon are all in-network with your insurance. Request a Good Faith Estimate (required under the 2022 No Surprises Act). After surgery, match every bill to your insurer's EOB, and dispute any out-of-network ancillary charges at cms.gov/nosurprises.

### What's the cheapest way to get bunion surgery?

For uninsured or high-deductible patients, the lowest-cost path is usually a bundled cash-pay rate at an ambulatory surgery center. These bundles run $5,500 to $9,500 and include surgeon, facility, anesthesia, and hardware. Hospital outpatient departments cost substantially more for the same surgery, and nonprofit hospitals have charity-care programs that can cut bills further if you qualify.

### Should I see an orthopedic surgeon or a podiatrist?

Both are qualified for this surgery. Orthopedic surgeons with foot-and-ankle fellowship training and podiatrists with board certification (ABFAS) get comparable outcomes. What matters more than the letters behind their name is how often they do this specific surgery; 20 or more per year is a reasonable volume benchmark.

### Where does this cost data come from?

Medicare payment figures come from the CMS Medicare Physician & Other Practitioners data, which reports the national average payment per HCPCS code across all providers who billed Medicare. Commercial and cash-pay ranges are informed by published hospital price transparency data and industry reporting; individual prices vary widely by market and insurer contract.

## Related

- [All procedure cost concepts](https://ourhealthnetwork.com/procedure-costs)
- [Find specialists who perform this procedure](https://ourhealthnetwork.com/find-doctors)
- [Insurance plans that cover this procedure](https://ourhealthnetwork.com/tools/insurance-matcher)