Complete excision of all lesser metatarsal heads (2nd through 5th) with partial proximal phalangectomy, excluding the first metatarsal — the Clayton-type forefoot reconstruction procedure.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,113.25
Total RVUs: 33.33
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCPayerpriceFindacodeMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify that all lesser metatarsal heads (2nd–5th) were excised and confirm first metatarsal was excluded from resection
Document the diagnosis driving the procedure — rheumatoid arthritis, severe metatarsalgia, or fixed forefoot deformity with MTPJ dislocation
Name the surgical approach and describe the extent of proximal phalangectomy performed at each ray
Record pre-operative imaging (weight-bearing foot X-rays) confirming structural deformity at multiple metatarsophalangeal joints
If billing alongside hammertoe repairs (28285), document each corrected digit separately with operative findings justifying distinct work
Include laterality (left or right foot) explicitly in both the operative note header and body — required for LT/RT modifier use

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 25 Significant separate E/M 51 Multiple procedures 57 Decision for surgery 58 Staged or related 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 28114 covers surgical removal of all lesser metatarsal heads (2nd through 5th) combined with partial resection of the proximal phalanges, excluding the first metatarsal. This is the Clayton-type procedure, performed primarily for severe rheumatoid forefoot deformity, end-stage metatarsalgia with multiple subluxed or dislocated MTPJs, or rigid forefoot deformity unresponsive to conservative care. It is a high-complexity foot reconstruction, not a single-head resection — that distinction drives both the RVU weight and the documentation bar.

The 90-day global period applies. Any E/M visit on the day before the procedure where the surgical decision is made requires modifier 57. Staged procedures in the post-op window — such as a planned contralateral foot reconstruction — need modifier 58. Unplanned returns to the OR for a related complication use modifier 78; unrelated procedures in the global window use modifier 79. Hammertoe corrections (28285) performed at the same operative session are commonly billed alongside 28114 with modifier 51 appended to the lower-valued code, but verify NCCI edits before billing the combination.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	11.7
Practice expense RVU	19.94
Malpractice RVU	1.69
Total RVU	33.33
Medicare national rate	$1,113.25
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	$1,113.25
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 28114 get rejected.

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

Missing laterality documentation when LT or RT modifier is appended — payer audits flag mismatches between modifier and op note
Bundling denial when 28114 is billed same-day with single-head ostectomy codes (28110–28113) without adequate documentation of distinct work
Medical necessity denial when diagnosis codes don't establish structural severity — a generic 'foot pain' ICD-10 code won't support this procedure
Global period denial for E/M visits during the 90-day post-op window billed without modifier 24 to establish an unrelated condition
Modifier 51 omitted when additional foot procedures are billed same-session, triggering multiple-procedure payment reduction disputes

Frequently asked questions

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

01Can I bill 28114 with 28285 for hammertoe corrections done at the same session?

Yes, but check NCCI edits first. When the operative note clearly documents separate and distinct work for each corrected digit alongside the Clayton-type resection, billing 28285 with modifier 51 (and appropriate toe modifiers) is supported. Forum guidance from AAPC coders confirms this approach for cases like 28285 on digits 2, 3, and 5 with 28114 for heads 2–5.

02Does 28114 include the first metatarsal head?

No. The procedure explicitly excludes the first metatarsal. If first metatarsal head work is performed, it requires separate coding — typically 28111 for complete first metatarsal head excision.

03What modifier applies if I'm billing an E/M visit the day I decide to perform this surgery?

Modifier 57 on the E/M code. Because 28114 carries a 90-day global, the decision-for-surgery visit on the day of or day before the procedure requires modifier 57 to be paid separately under Medicare.

04What ICD-10 diagnoses best support medical necessity for 28114?

Rheumatoid arthritis with forefoot deformity (M05.x71/M05.x72 with appropriate foot laterality), acquired deformities of the toes with MTPJ dislocation, and severe metatarsalgia with structural joint destruction are the strongest supporting diagnoses. Avoid generic 'foot pain' codes — they consistently trigger medical necessity reviews for this level of procedure.

05What is the global period for 28114, and what's included?

28114 carries a 90-day global. That covers the day-before visit (if not a decision-for-surgery E/M), the procedure itself, and all routine post-operative care through day 90 — including wound checks, dressing changes, and suture removal. Bill anything outside routine post-op care with modifier 24 (unrelated E/M) or 78/79 for return OR procedures.

06Is an assistant surgeon reimbursable for 28114?

Modifier 80 is listed as applicable. CMS payability for assistant surgeon services depends on whether the code is flagged as assistant-at-surgery eligible in the PFS indicator. Verify the AS modifier for non-physician surgical assistants and check your specific payer's policy — some commercial payers require pre-authorization for assistant surgeon billing on foot reconstruction.

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 rays operated on, confirms first metatarsal exclusion, documents the extent of proximal phalangectomy at each digit, and records operative laterality — all from surgeon dictation. This prevents the two most common 28114 audit flags: vague metatarsal head count and missing laterality that causes LT/RT modifier mismatches on claim submission.

See how Mira captures CPT 28114 documentation