Surgical removal of the synovial lining from an intertarsal or tarsometatarsal joint of the foot

Verified May 8, 2026 · 5 sources ↓

Medicare: $518.38
Work RVU: 5.11
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 5 cited references ↓

Specify the exact joint(s) involved — intertarsal vs. tarsometatarsal, and laterality (left/right/bilateral)
Document failure of conservative treatment and duration of symptoms prior to surgical intervention
Operative note must name the joint entered and confirm synovial tissue was excised, not just debrided
Pathology submission and report for excised synovium strongly supports medical necessity and confirms diagnosis
Pre-op imaging (X-ray, MRI) documenting synovitis or joint pathology consistent with surgical indication
ICD-10 diagnosis must align with the joint and condition treated — inflammatory arthropathy codes are most defensible

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 52 Reduced services 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 28070 describes a synovectomy of the intertarsal or tarsometatarsal joints — the midfoot articulations between tarsal bones and between tarsal and metatarsal bones. The surgeon excises the inflamed or diseased synovial membrane lining the joint cavity, typically indicated for persistent inflammatory arthropathy (rheumatoid arthritis, psoriatic arthritis, pigmented villonodular synovitis) that has failed conservative management.

The code carries a 90-day global period. All routine postoperative care through day 90 is bundled, including wound checks and suture removal. Any E/M service unrelated to the synovectomy during the global window requires modifier 24; a separately identifiable E/M on the day of surgery needs modifier 25. Per NCCI Chapter 4, debridement performed at the same joint during the same session is not separately reportable — only debridement at a different joint or unrelated site can be unbundled.

Podiatry dominates the PUF utilization data for this code. Bilateral cases are less common given the anatomy, but if performed bilaterally, report with modifier 50 on a single claim line for physician billing; ASC facilities report on two separate lines with modifiers LT and RT per CMS NCCI 2026 Chapter 4 guidance.

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 (5.11) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (15.52) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.11
Practice expense RVU	9.84
Malpractice RVU	0.57
Total RVU	15.52
Medicare national rate	$518.38
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	$518.38
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 28070 get rejected.

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

Medical necessity denied when documentation lacks evidence of failed conservative care (NSAIDs, orthotics, injections)
Unbundled debridement of the same joint denied under NCCI bundling — requires separate anatomic site to bill independently
Laterality missing or mismatched between claim and operative note triggers claim rejection or audit
ICD-10 code mismatch — degenerative arthritis codes without inflammatory component can undermine synovectomy necessity
Prior authorization not obtained when required by payer for elective midfoot surgical procedures

Frequently asked questions

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

01Can 28070 be billed for multiple joints in the same foot during the same session?

Yes, but each distinct joint requires its own unit. Use modifier 59 or XS to distinguish separate anatomic sites. Do not report more than one unit without identifying each joint individually in the operative note.

02Is debridement separately billable when performed at the same joint as the synovectomy?

No. Per NCCI Chapter 4, debridement at the same joint is bundled into 28070. Debridement is only separately reportable if performed on a different joint or an anatomically distinct site in the same session.

03What modifier applies if a patient returns to the OR within the 90-day global for a related complication?

Use modifier 78 for an unplanned return to the operating room for a procedure related to the original synovectomy. Modifier 79 applies only if the return procedure is entirely unrelated to 28070.

04How should a bilateral midfoot synovectomy be reported?

For physician billing, report 28070 with modifier 50 on a single line. For ASC billing, report two lines — one with modifier LT and one with modifier RT — each with one unit of service, per CMS NCCI 2026 Chapter 4.

05Which ICD-10 codes best support medical necessity for 28070?

Inflammatory arthropathy codes — rheumatoid arthritis (M05/M06), psoriatic arthritis (L40.5x), or pigmented villonodular synovitis (M12.27x) — are the most defensible. Primary osteoarthritis codes alone typically do not support synovectomy necessity without additional documentation of inflammatory component.

06Does the 90-day global include the pre-operative visit on the day before surgery?

Yes. The day-before visit is included in the global package for 090-day procedures. Bill it separately only if it was a decision-for-surgery visit, in which case modifier 57 applies.

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 joint name (intertarsal or tarsometatarsal), laterality, and confirmation that synovial tissue was excised from the operative dictation. It also flags documentation of prior conservative treatment and links the operative findings to the pre-op imaging diagnosis. This prevents the two most common denials for 28070: vague joint identification that auditors use to question site-specificity, and missing conservative-care history that payers cite to deny medical necessity.

See how Mira captures CPT 28070 documentation