Surgical removal of the first metatarsal head, typically performed to address osteomyelitis, avascular necrosis, or severe structural deformity of the first ray.

Verified May 8, 2026 · 5 sources ↓

Medicare: $472.96
Work RVU: 5.02
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPC

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Diagnosis driving the procedure: specify osteomyelitis, avascular necrosis, or named deformity with ICD-10 code
Operative note must identify the first metatarsal head by name as the resected structure — 'metatarsal head' alone is insufficient
Laterality documented in both the operative note and the billing record (left vs. right foot)
Pathology specimen disposition noted if bone sent for culture or histology (supports medical necessity for osteomyelitis cases)
Pre-operative imaging (X-ray, MRI, or bone scan) cited to establish extent of bone involvement
Wound closure technique and any fixation devices placed, documented in the operative note

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 50 Bilateral procedure 51 Multiple procedures 57 Decision for surgery 58 Staged or related 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 5 cited references ↓

CPT 28111 covers complete ostectomy of the first metatarsal head — the rounded distal end of the first metatarsal bone at the base of the big toe. The procedure is most often indicated for osteomyelitis with bone destruction, avascular necrosis, or a deformity that cannot be corrected by less destructive means. The surgeon incises down to the first metatarsal head, resects it, and closes in layers. This is a more aggressive intervention than a simple condylectomy or partial ostectomy and is coded separately from procedures on adjacent phalanges.

Carries a 90-day global period. All routine post-operative visits, wound checks, and suture removal through day 90 are bundled. Any E&M during that window for a separate, unrelated problem requires modifier 24. A separate decision-to-operate visit the day before or day of surgery — if truly significant and separately identifiable — requires modifier 57 if it led to the decision for a major procedure.

Sesamoidectomy performed at the same time is not separately billable; it is considered a component of the first metatarsal head work. When 28111 is billed same-day with other foot osseous procedures (e.g., proximal phalanx work under 28124), NCCI allows modifier 59/XS to bypass the bundle if the procedures are at distinct anatomic sites — confirm current NCCI PTP edits before appending.

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 (5.02) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (14.16) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.02
Practice expense RVU	8.59
Malpractice RVU	0.55
Total RVU	14.16
Medicare national rate	$472.96
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	$472.96
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 28111 get rejected.

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

Medical necessity not established — payer requires imaging or lab evidence of bone destruction before approving first metatarsal head resection
Laterality missing or mismatched between claim and operative report, triggering automated edit denial
Sesamoidectomy billed separately on same claim — payer bundles it into 28111 and denies the add-on line
E&M billed same-day without modifier 25 or 57, denied as included in the global surgical payment
Incorrect site descriptor in operative note (e.g., 'metatarsal' without specifying first ray or 'head') leads to downcoding or denial on audit

Frequently asked questions

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

01Is 28111 the right code if only part of the first metatarsal head is removed?

No. The CMS short descriptor says 'part removal of metatarsal,' but the clinical context for 28111 is complete excision of the first metatarsal head. Partial resections or condylectomies map to different codes in the 28288–28296 range. Verify the operative note specifies complete excision before using 28111.

02Can I bill a sesamoidectomy separately when performed at the same time as 28111?

No. Sesamoidectomy at the time of first metatarsal head excision is considered incidental to the primary procedure and is not separately reportable. Billing it separately will likely be denied or bundled by the payer.

03Which modifier do I use when 28111 is performed during the global period of a prior foot surgery for an unrelated problem?

Use modifier 79 for an unrelated procedure performed during the global period of a prior surgery. Modifier 78 is reserved for an unplanned return to the OR for a procedure related to the original surgery — do not use 78 for unrelated work.

04How do I bill 28111 with a same-day proximal phalanx procedure like 28124?

NCCI edits may bundle these. According to AAPC forum guidance consistent with NCCI policy, modifier 59 (or XS for distinct anatomic site) is allowed when the procedures are performed at genuinely distinct anatomic sites. Confirm the current NCCI PTP edit status before appending the modifier, and ensure the operative note documents each site separately.

05Does the 90-day global include the post-op visit where sutures are removed?

Yes. Suture removal, wound checks, and all routine recovery visits within the 90-day global period are bundled into 28111's payment. Bill a separate E&M only for a problem clearly unrelated to the foot surgery, and append modifier 24.

06Is modifier 50 appropriate if both first metatarsal heads are excised in the same session?

Yes. Bilateral first metatarsal head resection in a single operative session supports modifier 50. Confirm the operative note explicitly documents bilateral procedures and that the payer accepts modifier 50 for this code rather than requiring LT and RT on separate claim lines.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the resected structure by name (first metatarsal head), laterality, the indication (osteomyelitis, necrosis, or deformity), approach, and specimen disposition from dictation. That prevents the two most common audit flags: a vague operative note that says 'metatarsal' without specifying the first ray or the head, and missing laterality that triggers an automated claim edit.

See how Mira captures CPT 28111 documentation