Surgical excision of a lesion involving the tendon, tendon sheath, or joint capsule of the foot, which may include synovectomy of the extensor tendon sheath.

Verified May 8, 2026 · 7 sources ↓

Medicare: $469.28
Total RVUs: 14.05
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCFindacodePodiatrym

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Lesion location documented precisely — e.g., dorsal foot over extensor hallucis longus, not just 'foot lesion'
Lesion type identified: ganglion cyst, fibrous sheath mass, capsular lesion, or other — and confirmed by operative or pathology findings
Operative note must state whether synovectomy was performed and the extent of tissue excised
Preoperative diagnosis with supporting ICD-10 code that matches the excised structure (e.g., ganglion cyst M67.371/M67.372 for right/left foot)
Laterality documented in both the clinical note and the procedure note — required to support LT/RT modifier use
Medical necessity narrative: prior conservative treatment tried (injection, aspiration, splinting) or reason surgery was indicated without it

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 59 Distinct service 76 Repeat, same physician 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 7 cited references ↓

CPT 28090 covers open excision of a lesion — most commonly a ganglion cyst or fibrous mass — arising from the tendon, tendon sheath, or capsule structures of the foot. When the synovium is involved and removed as part of the same surgical session, that synovectomy is included and not separately billable. This is a distinct code from 28092, which applies to lesion excision involving the soft tissues of the toes.

The procedure carries a 90-day global period. All routine post-op visits, wound checks, and suture removals through day 90 are bundled. If you're managing an unrelated condition during that window, append modifier 24 (E/M) or 79 (procedure). A complication requiring a return to the OR for a related reason takes modifier 78 — not 79.

Site of service matters for reimbursement. The gap between HOPD and ASC payment is significant; see the site-of-service comparison table on this page. Bilateral foot cases — each foot with a separate lesion — bill with modifiers LT and RT on separate lines, or modifier 50 if your payer accepts that format. Confirm which format a specific payer requires before submitting.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	4.44
Practice expense RVU	9.13
Malpractice RVU	0.48
Total RVU	14.05
Medicare national rate	$469.28
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	$469.28
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 28090 get rejected.

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

Laterality modifier missing or mismatched between the claim and operative note
ICD-10 diagnosis code inconsistent with the excised structure — e.g., using a skin lesion code when the lesion arose from tendon sheath
Bundling denial when 28090 is billed same-day with a related foot procedure without modifier 59 or XS to establish distinct procedural service
Routine foot care exclusion applied by Medicare when documentation doesn't clearly distinguish surgical excision from debridement or routine nail/lesion care
Global period violation — post-op E/M billed without modifier 24 or a related return-to-OR procedure billed without modifier 78

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Is synovectomy separately billable when performed with 28090?

No. Synovectomy of the extensor tendon sheath performed during the same session is included in 28090. Billing a separate synovectomy code on the same foot same-day will be bundled and denied.

02What's the difference between 28090 and 28092?

28090 is for lesions involving the tendon, tendon sheath, or capsule of the foot. 28092 covers soft-tissue lesion excision on the toes. Foot versus toe anatomy is the differentiating factor — confirm lesion location in the operative note.

03How do I bill if the same lesion recurs and needs re-excision during the global period?

If the recurrence requires a return to the OR for the same foot lesion within the 90-day global, bill 28090 with modifier 78. Document why re-excision was necessary — incomplete initial excision or recurrence — in the operative note.

04Can I bill 28090 bilaterally if both feet have lesions?

Yes. Bill with modifiers LT and RT on separate lines. Some payers accept modifier 50 on a single line instead. Verify your payer's bilateral billing preference before submitting — incorrect format is a common technical denial.

05Does Medicare's routine foot care exclusion apply to 28090?

28090 is a surgical excision, not routine foot care, but Medicare auditors apply heightened scrutiny to foot procedure claims. Document the lesion's structure of origin, symptom burden, and why surgery was indicated. A note that reads like routine debridement will trigger that exclusion on review.

06When is modifier 22 appropriate for 28090?

Append modifier 22 when the excision is significantly more complex than typical — for example, a large infiltrative lesion requiring extensive dissection around neurovascular structures. Attach a cover letter with operative details; without documentation of the added complexity, payers will deny or ignore the modifier.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures lesion location, structure of origin (tendon, tendon sheath, or capsule), whether synovectomy was performed, laterality, and the prior conservative treatment history from dictation. That prevents the two most common denials for 28090: a vague operative note that triggers a routine foot care exclusion review, and a missing laterality modifier that auto-denies on split-billing claims.

See how Mira captures CPT 28090 documentation