Excision of a lesion from the tendon, tendon sheath, or joint capsule of one or more toes, which may include removal of diseased synovium from the extensor tendon sheath.

Verified May 8, 2026 · 5 sources ↓

Medicare: $422.52
Total RVUs: 12.65
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCFindacodeMdclarityEmedny

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Identify the specific toe(s) involved by name or number (e.g., second toe, left foot)
Describe the lesion type (e.g., ganglion cyst, fibroma) and its origin — tendon, tendon sheath, or capsule
Document whether synovectomy was performed and note the extent of synovium removed
Record pre-operative imaging or clinical findings supporting the presence of the lesion
Specify the surgical approach and confirm complete excision in the operative note
Note laterality (left vs. right foot) for accurate modifier assignment

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 51 Multiple procedures 59 Distinct service 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

28092 covers surgical excision of a lesion — such as a ganglion cyst or other soft-tissue mass — arising from the tendon, tendon sheath, or capsule of the toes. The procedure may include synovectomy of the extensor tendon sheath when diseased synovium is present. The code is billed per toe or per lesion site depending on payer rules, so confirm whether additional lesions on separate toes require modifier 59 or separate line items before submitting.

The 90-day global period means all routine follow-up is bundled into the surgical payment. Post-op visits for the same foot lesion — dressing changes, suture removal, wound checks — are included. If you need to bill an E/M during the global for an unrelated problem, attach modifier 24. A new procedure on a separate, unrelated condition during the global requires modifier 79.

Podiatry performs the overwhelming majority of 28092 claims. Orthopedic surgeons billing this code should ensure the operative note clearly describes the anatomic location (specific toe, tendon or sheath involved) and the lesion type. Vague documentation like 'toe mass excised' is an audit red flag and a common reason payers request medical records before paying.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	3.69
Practice expense RVU	8.57
Malpractice RVU	0.39
Total RVU	12.65
Medicare national rate	$422.52
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	$422.52
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 28092 get rejected.

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

Missing or vague operative note — 'toe mass excised' without anatomic specificity triggers medical record requests
Laterality modifier absent (LT or RT required by most commercial payers and Medicare MACs)
Claim submitted during the global period of a prior foot procedure without modifier 79 or 24
ICD-10 diagnosis code does not support a tendon, tendon sheath, or capsule origin (e.g., using a skin lesion code for a deep soft-tissue mass)
Multiple toe lesions billed without modifier 59 to distinguish separate anatomic sites

Frequently asked questions

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

01Does 28092 cover excision of a lesion from any toe, including the great toe?

Yes. 28092 applies to lesions of the tendon, tendon sheath, or capsule of any toe. Confirm the lesion origin is deep soft tissue, not skin — skin lesions on the toe bill under integumentary codes.

02If lesions are excised from two separate toes in the same session, how do you bill?

Bill 28092 for the first toe. For additional toes excised in the same session, bill 28092 again with modifier 59 to indicate a distinct anatomic site. Some payers may also require modifier 51 on the second unit — confirm the payer's multiple-procedure policy before submitting.

03What modifier is required when billing 28092 on a Medicare claim?

Attach LT or RT to identify laterality. Most MACs require it; missing this modifier is a common reason for rejection or pre-payment review requests.

04Is a synovectomy separately billable when performed alongside the lesion excision?

No. Synovectomy of the extensor tendon sheath is included in 28092 when performed at the same site. Do not bill a separate synovectomy code for the same toe in the same session.

05What happens if a patient returns during the 90-day global for a wound complication at the surgical site?

If you return to the OR to manage a complication related to the original procedure, that is a global-period related service — use modifier 78. If it's a completely unrelated new procedure during the 90-day window, use modifier 79. Never use these two modifiers interchangeably.

06Which diagnosis codes typically support 28092?

Ganglion cysts (M67.3x), other tendon sheath disorders, and benign soft-tissue neoplasms of the foot are the most common supporting diagnoses. A skin lesion ICD-10 code paired with 28092 creates a diagnosis-procedure mismatch that will generate a denial or ADR.

Sources & references

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

01CMS Physician Fee Schedule 2026
02
aapc.com
https://www.aapc.com/codes/cpt-codes/28092
03
findacode.com
https://www.findacode.com/cpt/28092-cpt-code.html
04
mdclarity.com
https://www.mdclarity.com/cpt-code/28092
05
emedny.org
https://www.emedny.org/providermanuals/physician/pdfs/physician%20procedure%20codes%20sect5.pdf

Mira AI Scribe

Mira's AI scribe captures the lesion's anatomic origin (tendon, tendon sheath, or capsule), the specific toe and laterality, whether synovectomy was performed, and the lesion type from the surgeon's dictation. That detail set prevents the two most common denials for 28092: missing laterality and diagnosis-procedure mismatch when a skin lesion code is assigned to a deep soft-tissue excision.

See how Mira captures CPT 28092 documentation