Open incision into a toe joint to inspect the joint space, drain infected fluid, and remove debris or foreign material.

Verified May 8, 2026 · 4 sources ↓

Medicare: $473.29
Work RVU: 4.41
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCAAOS

Documentation requirements

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

Source · Editorial brief grounded in 4 cited references ↓

Specify which toe and which joint (IP, MTP, DIP, PIP) was explored by name — vague references to 'toe joint' are an audit flag
Document the indication for open exploration: septic arthritis, foreign body, osteomyelitis suspicion, or failed non-operative management
Describe intraoperative findings in detail: appearance of synovium, presence of purulence, debris, foreign material, or cartilage damage
Record the irrigation volume and any cultures or specimens sent to pathology or microbiology
Note closure technique and any drains placed, since these affect post-op global period management documentation
If modifier 22 is appended, the operative note must explicitly describe what made the work substantially greater than usual — adhesions, distorted anatomy, prolonged irrigation

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 50 Bilateral procedure 51 Multiple procedures 57 Decision for surgery 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 4 cited references ↓

CPT 28024 covers open surgical exploration of a toe joint — typically performed to evaluate and address septic arthritis, osteomyelitis involvement at the joint, a retained foreign body, or persistent joint pathology that hasn't responded to conservative measures. The surgeon incises down to the joint capsule, opens it, inspects the joint surfaces, irrigates, and removes infectious material or debris. This is an open procedure, not arthroscopic.

The code carries a 90-day global period. Any E/M service billed the day of or day before requires modifier 57 if it represents the decision for surgery. Unrelated office visits during the 90-day post-op window need modifier 24. If a separate, significantly identifiable procedure is performed at the same session on a different anatomic site, use modifier 59 to bypass bundling edits.

Bilateral toe joint exploration — uncommon but possible in bilateral septic arthritis — requires modifier 50 for physician billing. ASC facilities should report bilateral cases on two separate claim lines with modifiers LT and RT per CMS NCCI policy.

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 (4.41) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (14.17) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	4.41
Practice expense RVU	9.27
Malpractice RVU	0.49
Total RVU	14.17
Medicare national rate	$473.29
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	$473.29
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 28024 get rejected.

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

Medical necessity not established — diagnosis codes for routine bunion or hallux deformity don't support open joint exploration
Missing laterality documentation: claim submitted without LT/RT when payer requires it, or operative note doesn't specify the toe
Bundling conflict when 28024 is billed same-day with debridement or I&D codes without modifier 59 to establish distinct anatomic site or service
Global period violation — follow-up visit billed without modifier 24 when it falls within the 90-day post-op window
Insufficient pathology or infection documentation to justify open approach over closed aspiration or I&D

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 4 cited references ↓

01Can 28024 be billed for a simple I&D of a toe infection without entering the joint?

No. 28024 is specifically for open exploration of the joint space. A soft-tissue I&D that doesn't enter the joint capsule should be coded to the appropriate wound or abscess drainage code. Document joint entry explicitly in the operative note.

02What modifier applies if I perform 28024 and then need to return the same patient to the OR within the 90-day global for a related complication?

Use modifier 78 — unplanned return to the OR for a procedure related to the original surgery during the global period. Modifier 79 is for an unrelated procedure. Don't invert them.

03Is modifier 57 ever appropriate with 28024?

Yes. Because 28024 has a 90-day global period, if you make the decision for surgery at an E/M visit the day of or day before the procedure, append modifier 57 to the E/M code to allow separate payment for that visit.

04Can 28024 and a bone debridement code be billed together on the same day?

Potentially, if distinct work was performed — for example, joint exploration plus debridement of adjacent osteomyelitic bone at a clearly separate site. You'll need modifier 59 and an operative note that documents each procedure as distinct. Expect scrutiny and have your documentation tight before submitting.

05How should bilateral toe joint exploration be billed in an ASC versus a physician claim?

For a physician claim, report 28024 once with modifier 50. For an ASC, report two claim lines — each with one unit — using modifier LT on one line and RT on the other, per CMS NCCI billing policy.

06What ICD-10 codes typically support medical necessity for 28024?

Septic arthritis of the toe joint (M00.071–M00.079), osteomyelitis with joint involvement, foreign body in the foot (codes from the T18/T14 range with appropriate specificity), and adjacent wound infection with joint penetration are the strongest supporting diagnoses. Degenerative or deformity-only diagnoses will not support medical necessity for open exploration.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the specific toe and joint level explored, operative indication, intraoperative findings (purulence, foreign body, synovial appearance), irrigation details, and specimen disposition from surgeon dictation. This prevents the most common audit flag for 28024: an operative note that names the procedure without documenting what was found or why open exploration was chosen over aspiration.

See how Mira captures CPT 28024 documentation