Surgical removal of the entire fifth metatarsal head, typically performed to relieve pain from osteomyelitis, necrosis, diabetic foot ulcers, or structural deformity at the fifth ray.

Verified May 8, 2026 · 7 sources ↓

Medicare: $584.52
Total RVUs: 17.5
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCPodiatrymCgsmedicareAacpm

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Operative note must state 'complete excision' of the fifth metatarsal head — partial resection maps to a different code and auditors look for this distinction
Indication documented in the pre-op note: osteomyelitis, necrosis, ulceration, or specific structural pathology driving the resection
Imaging (X-ray, MRI, or bone scan) referenced in the record confirming fifth metatarsal head pathology prior to surgery
If bone or tissue sent to pathology, document specimen label, collection method, and purpose (culture, histopathology) in the operative note
For diabetic patients, document wound classification, vascular status, and any pre-op infectious workup to support medical necessity
If 28126 billed same-day for phalangeal base resection, the operative note must describe that work as a distinct, separately documented step

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 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 50 Bilateral procedure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 28113 covers complete resection of the fifth metatarsal head — the distal end of the fifth ray where it articulates with the proximal phalanx. The procedure is most commonly indicated for osteomyelitis in diabetic patients, avascular necrosis, or intractable pain from fifth metatarsophalangeal joint pathology that has failed conservative management. It is distinct from 28110, which covers only partial excision of the fifth metatarsal head for bunionette correction, and from 28114, which covers all metatarsal heads. If the surgeon also resects the proximal phalangeal base, add 28126 separately — that work is not bundled into 28113.

The 90-day global period means all routine post-op office visits, wound checks, and suture removal through day 90 are included in the surgical payment. For diabetic patients, wound care performed within the global that goes beyond routine management — such as separate debridement of a distinct wound — may be separately billable with modifier 24, provided documentation clearly distinguishes it from standard post-op care. Tissue or bone sent to pathology (e.g., for osteomyelitis confirmation or malignancy workup) is separately reportable; document specimen submission explicitly in the operative note.

Site-of-service matters here: the HOPD and ASC payment rates differ significantly (see the site-of-service comparison table on this page). Podiatry claims the dominant share of 28113 volume per CMS Physician Utilization File data, but orthopedic surgeons bill it as well. Payers may require prior authorization when the indication is chronic osteomyelitis secondary to diabetic foot ulcer, particularly if bone imaging or nuclear medicine studies were not obtained pre-op.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.96
Practice expense RVU	10.94
Malpractice RVU	0.6
Total RVU	17.5
Medicare national rate	$584.52
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	$584.52
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 28113 get rejected.

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

Miscoding as 28110 (partial fifth metatarsal head excision for bunionette) when the operative note describes complete resection — or vice versa
Missing or inadequate medical necessity documentation for the complete resection, especially when the indication is diabetic osteomyelitis without pre-op imaging on file
Unbundling 28113 with 28114 (all metatarsal heads) on the same foot — these are mutually exclusive; use 28114 if all heads are resected
Billing routine post-op visits within the 90-day global without modifier 24, resulting in denial of the E/M claim
Laterality modifier absent (LT or RT) causing claim rejection or payer-specific denial on bilateral surgery claims

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, used specifically for bunionette correction. 28113 is complete excision of the fifth metatarsal head. The distinction hinges on how much bone is removed and the surgical intent — auditors will compare the operative note to the code billed. 'Partial' and 'complete' are not interchangeable.

02Can I bill 28113 and 28114 together on the same foot?

No. 28114 covers complete excision of all metatarsal heads including the first. If all heads are resected, bill 28114 only. Billing 28113 alongside 28114 on the same foot is an NCCI bundling issue — the lesser code will deny.

03Can 28126 be billed with 28113 on the same encounter?

Yes, if the surgeon also resects the proximal phalangeal base, 28126 is separately reportable. Document the phalangeal base resection as a distinct step in the operative note. Per Podiatry Management Codingline guidance, this combination is appropriate for diabetic foot cases involving both the metatarsal head and adjoining phalanx.

04What modifiers are required when billing 28113 on both feet in the same session?

Use modifier 50 for bilateral billing, or append LT and RT to separate line items per payer preference. Confirm with each payer — some commercial plans and MACs have specific bilateral billing rules that differ from standard Medicare guidance.

05Does the 90-day global period include diabetic wound care visits after the resection?

Routine post-op wound checks are bundled into the global. Wound care that is distinct from routine post-op management — such as separate debridement of a new or unrelated wound — can be billed with modifier 24 on the E/M or modifier 79 on a separate procedure, but the documentation must explicitly separate that service from standard surgical follow-up.

06Is pathology billing separately allowed when bone is sent for osteomyelitis culture after 28113?

Yes. Bone or tissue submitted for pathology or culture is separately reportable with the appropriate pathology CPT code. Document specimen submission, collection method, and clinical purpose in the operative note to support both claims.

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 surgeon's dictated indication (osteomyelitis, necrosis, ulceration), confirms the word 'complete' versus 'partial' resection of the fifth metatarsal head, flags any concurrent phalangeal base work for separate 28126 coding, and notes whether bone or tissue was submitted to pathology. This prevents the most common audit trigger for 28113: an operative note that describes extent of resection ambiguously, leaving coders to guess between 28110, 28113, and 28114.

See how Mira captures CPT 28113 documentation