Surgical partial excision of the fifth metatarsal head, typically performed to correct a bunionette (tailor's bunion) by removing the prominent lateral bony prominence.

Verified May 8, 2026 · 7 sources ↓

Medicare: $467.28
Work RVU: 4.11
Global, days: 90
Region: Foot & ankle

Drawn from MdclarityAAPCCMSPayerpriceAacpm

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Diagnosis of bunionette or fifth metatarsal head deformity with clinical symptoms (pain, impingement, footwear difficulty)
Operative note specifying partial — not complete — excision of the fifth metatarsal head and amount of bone removed
Laterality documented explicitly (left foot, right foot, or bilateral) to support LT/RT/50 modifier use
If billed same-day with 28308 or a bunionectomy code, a separate paragraph in the operative note describing each distinct procedure and its medical necessity
Pre-operative imaging (weight-bearing foot X-rays) demonstrating the osseous deformity
Conservative treatment history to establish medical necessity prior to surgical intervention

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 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 28110 describes partial removal of the fifth metatarsal head — the osseous resection used to address a bunionette deformity at the fifth metatarsophalangeal joint. The surgeon incises down to the fifth metatarsal head and removes the offending bony prominence from the lateral aspect, stopping short of complete head excision. This distinguishes 28110 from 28113, which covers complete excision of the fifth metatarsal head.

28110 carries a 90-day global period. All routine post-op visits, dressing changes, and stitch removals through day 90 are bundled. Anything unrelated to the bunionette during that window needs modifier 24 (E/M) or 79 (unrelated procedure). If a concurrent osteotomy of a lesser metatarsal (28308) is performed in the same session, NCCI bundling applies — modifier 59 is required to unbundle when the procedures are distinct and separately documented. CPT Assistant (December 2010) confirms 28110 carries a 'separate procedure' designation and can be reported alongside a bunionectomy with modifier 59 when performed as a distinct service.

This code is predominantly billed by podiatry. When performed same-day with a hallux valgus correction on the same foot, coders must support medical necessity for both deformities independently in the operative note. Payers will scrutinize same-day forefoot procedure combinations — document each deformity, its symptoms, and its discrete surgical steps.

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 (4.11) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (13.99) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	4.11
Practice expense RVU	9.42
Malpractice RVU	0.46
Total RVU	13.99
Medicare national rate	$467.28
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	$467.28
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 28110 get rejected.

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

Bundling with concurrent metatarsal osteotomy (28308) without modifier 59 to establish distinct procedural service
Missing laterality modifier — payers require LT or RT for unilateral foot procedures; claims without laterality are frequently rejected
Insufficient medical necessity documentation — operative note describes deformity but lacks symptom history or failed conservative care
Upcoding flags when 28110 (partial excision) is billed but operative note describes complete head resection, which maps to 28113
Global period conflicts — post-op E/M visits billed without modifier 24 during the 90-day global are automatically denied

Frequently asked questions

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

01What is the difference between 28110 and 28113?

28110 is partial excision of the fifth metatarsal head — only the lateral prominence is removed. 28113 is complete excision of the fifth metatarsal head. The operative note must specify which was performed; billing 28110 when the note documents complete removal is a code-to-documentation mismatch.

02Can 28110 be billed with a bunionectomy (e.g., 28296) on the same day?

Yes, but only when the bunionette and hallux valgus deformities are each separately documented with distinct symptom history, medical necessity, and surgical steps. Append modifier 59 to 28110 to identify it as a distinct procedural service. CPT Assistant December 2010 explicitly supports this pairing with modifier 59.

03Can 28110 be billed with 28308 (metatarsal osteotomy) on the same day?

NCCI bundles 28308 as a column 1 code with 28110 in column 2, but the modifier indicator allows unbundling. If the osteotomy and partial excision are distinct procedures on separately documented deformities, append modifier 59 to 28110. Without it, the claim bundles and 28308 drives reimbursement.

04What modifier is required for a bilateral bunionette excision?

Modifier 50 for bilateral same-session procedures. If performed on separate dates, use LT and RT on separate claim lines. Most payers reimburse the second side at 50% of the allowable — confirm payer-specific bilateral payment policy before submitting.

05Does the 90-day global period affect how I bill a post-op complication return to the OR?

Yes. If the patient returns to the OR for a complication related to the bunionette excision — such as wound dehiscence requiring surgical repair — append modifier 78 to the return procedure. Modifier 79 applies only if the return procedure is completely unrelated to the original surgery. Do not invert these modifiers; doing so is an audit flag.

06Is 28110 a 'separate procedure' code, and what does that mean practically?

Yes. The 'separate procedure' designation means 28110 is typically considered a component of more extensive forefoot surgery and should not be billed alongside a related major procedure unless it was performed at a distinctly different anatomic site or for a distinct diagnosis. When it qualifies as a distinct service, modifier 59 overrides the separate procedure status.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the extent of bony resection (partial vs. complete), the specific metatarsal head involved (fifth), laterality, and the surgeon's description of the bunionette deformity and symptoms from dictation. It flags when the note says 'complete excision' — which points to 28113, not 28110 — preventing a mismatch between the operative report and the billed code that auditors catch on review.

See how Mira captures CPT 28110 documentation