Radical resection of a soft tissue tumor of the foot or toe, with the tumor measuring 3 cm or larger in greatest dimension.

Verified May 8, 2026 · 5 sources ↓

Medicare: $957.27
Work RVU: 17.01
Global, days: 90
Region: Foot & ankle

Drawn from CMSFindacodeAAPC

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Tumor size documented in centimeters — the lesion itself, not the excision margins or specimen size
Operative note specifies 'radical resection' with description of tissue margins removed beyond the tumor capsule
Anatomic location within the foot or toe identified precisely (e.g., plantar forefoot, dorsum of hallux)
Pre-operative imaging or biopsy report supporting suspected or confirmed neoplasm
Pathology report ordered and linked to the encounter; confirmed diagnosis must reconcile with ICD-10 coding
Any neurovascular structures encountered or preserved noted in the operative report

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 28047 covers radical resection of a soft tissue tumor — such as a malignant neoplasm — of the foot or toe when the lesion measures 3 cm or greater. 'Radical resection' means the surgeon removes the tumor along with a margin of surrounding normal tissue, not a simple excision. The 3 cm threshold distinguishes this code from 28046, which covers tumors smaller than 3 cm. Measure the tumor itself, not the total excision specimen, to select the correct code.

The 90-day global period applies. Routine post-op visits, wound checks, and suture removal through day 90 are bundled. Unrelated problems evaluated in that window require modifier 24 on the E/M. A staged or more extensive procedure in the global period needs modifier 58; an unplanned return for a related complication takes modifier 78.

Pathology is not optional — it drives diagnosis coding and supports medical necessity. If the pre-op diagnosis is a suspected malignancy, the ICD-10 code should reflect that. Once the path report returns, update to the confirmed histologic diagnosis. Avoid R22.- codes when the mass is deeper than subcutaneous tissue; payers flag those as insufficiently specific for a radical resection claim.

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 (17.01) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (28.66) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	17.01
Practice expense RVU	8.94
Malpractice RVU	2.71
Total RVU	28.66
Medicare national rate	$957.27
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	$957.27
HOPD (APC 5073) Hospital outpatient department	$2,967.63
ASC (PI G2) Ambulatory surgical center (freestanding)	$1,248.36

Common denial reasons

The recurring reasons claims for CPT 28047 get rejected.

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

Tumor size not documented or measurement reflects specimen rather than the lesion itself, making 28047 vs. 28046 selection unverifiable
ICD-10 diagnosis coded as R22.- (localized swelling) for a lesion deeper than subcutaneous tissue — payers deny or downcode when diagnosis doesn't support radical resection
Claim billed during 90-day global period of a prior foot procedure without modifier 79 or 58, triggering bundling denial
Operative note describes 'excision' without language supporting radical resection with margins, leading auditors to downcode to a simple excision code
Missing or delayed pathology report leaves medical necessity for malignant-level resection unsubstantiated on post-pay audit

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What is the difference between CPT 28046 and 28047?

Size threshold. 28046 is for radical resection of a foot or toe soft tissue tumor smaller than 3 cm. 28047 applies when the tumor measures 3 cm or greater. Measure the tumor, not the excision specimen.

02Does 28047 require a confirmed malignancy diagnosis?

No — the code describes the surgical technique (radical resection with margins), not a confirmed histologic result. You can bill with a suspected malignancy or neoplasm of uncertain behavior diagnosis pre-pathology, then update the diagnosis once the report returns.

03Can I bill 28047 with a same-day E/M?

Only if the E/M is a separately identifiable service unrelated to the decision to operate. Append modifier 25 to the E/M. If the visit drove the decision to perform the resection that same day, modifier 57 applies instead.

04How does the 90-day global period affect billing for post-op complications?

Routine post-op care is bundled through day 90. If the patient returns for an unplanned procedure to address a related complication (e.g., wound dehiscence requiring return to OR), bill the procedure code with modifier 78. An unrelated surgical procedure in the global window takes modifier 79.

05Is 28047 subject to NCCI bundling with wound closure codes?

Yes. Per NCCI policy, closure of the surgical incision is included in the global surgical package and cannot be billed separately. Don't add a repair or closure code unless it involves a distinctly separate wound at a separate anatomic site.

06When is modifier 22 appropriate for 28047?

When the resection is substantially more work than typical — for example, extensive neurovascular dissection, unusually large margins required by tumor location, or a reoperative field with significant scarring. Document the increased complexity explicitly in the operative note; vague language won't support the modifier on audit.

Sources & references

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

Mira Scribe

Mira's AI scribe captures tumor size in centimeters from dictation, the specific anatomic site within the foot or toe, the surgical approach and margin description, and neurovascular findings — then flags if the operative note lacks 'radical resection' language or if tumor dimensions aren't explicitly stated. That prevents downcoding to 28046 or a simple excision code on audit.

See how Mira captures CPT 28047 documentation