Surgical removal of a tarsal coalition — an abnormal bony, cartilaginous, or fibrous bridge between two or more tarsal bones that restricts hindfoot or midfoot motion.

Verified May 8, 2026 · 5 sources ↓

Medicare: $671.02
Work RVU: 8.91
Global, days: 90
Region: Foot & ankle

Drawn from AAPCFindacodePayerpriceCMS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Identify the specific coalition type by location (e.g., calcaneonavicular, talocalcaneal, talonavicular) and tissue composition (bony, cartilaginous, or fibrous)
Document preoperative imaging — weight-bearing radiographs and CT or MRI confirming coalition anatomy and extent
Operative note must name the resection technique and the interposition material used (fat graft, EDB muscle, bone wax) to demonstrate complete excision
Record intraoperative fluoroscopy findings if used to confirm adequacy of resection
Note laterality explicitly (left, right, or bilateral) in both the operative report and claim
Document conservative treatment failure (physical therapy, orthotics, casting) prior to surgical authorization

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 57 Decision for surgery 58 Staged or related 59 Distinct service 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 28116 covers excision of a tarsal coalition, the abnormal union between tarsal bones that limits subtalar and transverse tarsal joint motion. The coalition may be calcaneonavicular, talocalcaneal, or involve other tarsal articulations, and the tissue bridge can be bony (synostosis), cartilaginous (synchondrosis), or fibrous (syndesmosis). The surgeon resects the coalition and typically interposes fat, extensor digitorum brevis muscle, or bone wax to prevent recurrence.

This is a 90-day global procedure. All routine post-op visits, wound checks, and cast changes through day 90 are bundled — bill separately only for distinct, unrelated services using modifier 79, or for unplanned returns to the OR for related complications using modifier 78. When a same-day E/M drives the decision to operate (same encounter, new decision), attach modifier 57 to the E/M.

Tarsal coalitions are frequently bilateral, and staged contralateral resection is common. If both feet are addressed in the same operative session, append modifier 50. If the contralateral foot is addressed in a separate session during the global period of the first, use modifier 79 with clear documentation that the procedures are anatomically distinct.

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 (8.91) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (20.09) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	8.91
Practice expense RVU	10.42
Malpractice RVU	0.76
Total RVU	20.09
Medicare national rate	$671.02
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	$671.02
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 28116 get rejected.

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

Missing or inadequate conservative treatment failure documentation before surgical authorization
Laterality not specified on the claim — LT or RT modifier absent causes processing errors with many payers
ICD-10 diagnosis code mismatch: coalition-specific diagnoses (Q66.89, M89.8X7) not linked to 28116
Bundling conflicts when arthroscopy or other foot excision codes are billed same-day without modifier 59 or XS establishing distinct anatomical sites
Bilateral procedure billed as two separate line items without modifier 50, triggering duplicate-claim edits

Frequently asked questions

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

01Is 28116 ever billed bilaterally in one session?

Yes. When both feet are operated on during the same session, append modifier 50 to a single 28116 line. Don't bill two separate lines with LT and RT — that triggers duplicate-claim edits with most payers. Some payers still prefer two lines; verify your MAC's preference before submitting.

02What ICD-10 codes support 28116?

Tarsal coalition diagnoses fall primarily under Q66.89 (other congenital deformities of feet) and M89.8X7 (other specified disorders of bone, ankle and foot). Use the most specific code available and confirm the diagnosis links logically to surgical excision — vague musculoskeletal pain codes alone draw scrutiny.

03Can 28116 be billed with other foot excision codes on the same date?

Only if distinct anatomical sites are involved. NCCI edits bundle many foot excision codes together. If work at a separate site genuinely warrants an additional code, append modifier 59 or XS and document the distinct location in the operative note.

04What modifier applies if the patient returns to the OR within the global period for coalition re-excision due to recurrence?

Use modifier 78 — unplanned return to the OR for a procedure related to the original surgery during the global period. Document the recurrence or incomplete initial resection clearly. Modifier 79 is for unrelated procedures only.

05Does modifier 22 apply to a complex coalition resection?

It can, but the bar is high. Modifier 22 requires documentation showing substantially increased physician work beyond the typical case — for example, extensive bony bridging requiring additional osteotomy, or scarring from prior surgery significantly complicating dissection. Attach a cover letter quantifying the extra time and complexity; without it, most payers deny the upcharge.

06What site-of-service options are typical for 28116?

28116 is performed in hospital outpatient departments (POS 22) and ASCs (POS 24). See the Site of Service comparison on this page for the payment differential between HOPD and ASC settings, which is substantial.

Sources & references

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

Mira Scribe

Mira's AI scribe captures coalition location (calcaneonavicular vs. talocalcaneal), tissue type (bony/cartilaginous/fibrous), laterality, resection technique, and interposition material directly from surgeon dictation. That detail prevents the two most common 28116 denials: missing coalition-specific diagnosis linkage and absent laterality modifiers.

See how Mira captures CPT 28116 documentation