Complete excision of the second, third, or fourth metatarsal head, performed for conditions such as rheumatoid arthritis, avascular necrosis, osteomyelitis, or chronic deformity causing intractable metatarsalgia.

Verified May 8, 2026 · 7 sources ↓

Medicare: $481.97
Work RVU: 4.51
Global, days: 90
Region: Foot & ankle

Drawn from AAPCMdclarityPodiatrymPayerpriceCMS

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify which metatarsal head(s) were excised by number (second, third, fourth) — notes that say 'lesser metatarsal' without specifying the ray are not sufficient.
Document the indication: diagnosis driving resection (e.g., rheumatoid arthritis, avascular necrosis, osteomyelitis) must link directly to the excised ray(s).
Operative note must confirm complete excision of the metatarsal head, not partial resection — partial removal of lesser metatarsal heads maps to a different code family.
If multiple 28112 units are billed, document each ray separately within the operative note with distinct surgical steps or explicit language identifying each head removed.
Record laterality (right vs. left foot) to support LT/RT modifier assignment and ICD-10-CM laterality codes.
Preoperative imaging (X-ray or MRI) supporting the pathology should be referenced in the operative note to substantiate medical necessity.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 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 28112 covers complete surgical removal of the metatarsal head of the second, third, or fourth ray. It is most commonly performed in the setting of rheumatoid forefoot reconstruction, avascular necrosis, or osteomyelitis where the metatarsal head is no longer salvageable. The code is distinct from 28110 (partial fifth metatarsal head excision), 28111 (complete first metatarsal head), and 28113 (complete fifth metatarsal head) — selecting the wrong code based on ray number is a fast path to a denial.

When multiple rays are resected in the same session — common in rheumatoid pan-metatarsal head resection — bill 28112 on separate lines for each of the second, third, and fourth heads. The MUE for this code is 4 units per date of service. Medicare does not require modifier 51; its claims system applies multiple procedure reductions automatically. Some commercial payers still want modifier 51 appended, and others expect modifier 59. Payer-specific conventions vary; check MAC and commercial policies before assuming one approach fits all.

The 90-day global period applies. Any unrelated surgical procedure during that window requires modifier 79; an unplanned return to the OR for a related problem requires modifier 78. Extensor tendon resection performed as part of the metatarsal head excision is bundled — do not code it separately. When 28112 is performed alongside first MPJ fusion (28750), hammertoe repairs (28285), or fifth metatarsal head resection (28113), each procedure is separately payable, but rank them correctly by RVU and apply anatomical modifiers to distinguish laterality and ray.

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 (4.51) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (14.43) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	4.51
Practice expense RVU	9.43
Malpractice RVU	0.49
Total RVU	14.43
Medicare national rate	$481.97
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	$481.97
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 28112 get rejected.

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

Wrong code for the ray resected — billing 28112 for a first or fifth metatarsal head excision instead of 28111 or 28113 triggers a mismatch denial.
Multiple units submitted without distinct per-ray documentation — payers deny duplicate lines when the operative note doesn't individually describe each metatarsal head removed.
Extensor tendon resection billed separately alongside 28112 — it is a bundled component of the excision and will be denied as unbundling.
Missing or mismatched laterality modifiers when bilateral cases or multi-ray cases are submitted without LT/RT or anatomical modifiers to differentiate lines.
Insufficient medical necessity documentation — diagnosis codes that don't clearly correspond to the specific ray(s) excised (e.g., a unilateral ICD-10 code on a bilateral claim).

Frequently asked questions

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

01Can 28112 be billed more than once on the same date of service?

Yes. Bill one unit per metatarsal head resected, on separate claim lines, for the second, third, and fourth rays. The Medicare MUE is 4 units per date of service. Each line needs anatomical support in the operative note.

02Does modifier 51 need to be appended when billing multiple units of 28112?

Medicare explicitly does not want modifier 51 submitted — it applies the multiple procedure reduction automatically. Some commercial payers still require it; others prefer modifier 59. Check your MAC and commercial payer policies.

03Should T-modifiers (toe digit modifiers) be used with 28112?

T modifiers are technically intended for phalanges, not metatarsals. In practice, some payers require them to distinguish rays on a multi-unit claim; others accept LT/RT only. Payer-specific — confirm before submitting.

04What is the global period for 28112, and what does it cover?

The global period is 90 days. It includes the day-before visit, the surgery day, and all routine post-op care through day 90. Unrelated procedures during that window require modifier 79; an unplanned related return to the OR requires modifier 78.

05Is extensor tendon resection billable separately when performed with 28112?

No. Extensor tendon resection at the metatarsal-phalangeal joint level performed as part of the metatarsal head excision is a bundled component. Billing it separately is considered unbundling and will be denied.

06When a full pan-metatarsal resection (rays 1–5) is performed, how should it be coded?

Code 28111 for the first, 28112 for the second through fourth (up to three separate lines), and 28113 for the fifth. Do not default to 28114 unless proximal phalangectomies were also performed — that code includes partial base resections.

07What ICD-10 codes most commonly support 28112 medical necessity?

M06.x (rheumatoid arthritis with foot joint involvement), M87.x (osteonecrosis), M86.x (osteomyelitis), and M77.4x (metatarsalgia) are the most common supporting diagnoses. Laterality must match the operative report.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the specific metatarsal ray number(s) excised, the surgical indication, and laterality directly from dictation — flagging any missing ray-specific language before the note is finalized. That prevents the most common 28112 denial: a claim with multiple units and a generic operative note that auditors reject as duplicate billing.

See how Mira captures CPT 28112 documentation