Surgical removal of a portion or all of the calcaneus (heel bone), performed for infection, necrosis, or structural bone pathology of the heel.

Verified May 8, 2026 · 6 sources ↓

Medicare: $631.95
Total RVUs: 18.92
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCPodiatrymCgsmedicareFastrvu

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify whether excision involves the calcaneal body (28118) vs. an isolated spur (28119) — operative note must name which structure was removed.
Document the clinical indication: osteomyelitis, avascular necrosis, Haglund's deformity, or other structural pathology driving resection.
Record conservative treatment attempts and their failure before surgical intervention to support medical necessity.
Note laterality explicitly (left, right, or bilateral) in both the operative report and the diagnosis coding.
Document extent of bone removed and any concurrent procedures (e.g., soft tissue debridement) performed in the same operative session.
If a post-op cast is applied in the office during the global period, document why it represents a separately billable service distinct from routine post-op care.

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 52 Reduced services 58 Staged or related 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 6 cited references ↓

CPT 28118 covers ostectomy of the calcaneus — removal of calcaneal bone tissue when infection, necrosis, or significant structural abnormality (including Haglund's deformity) makes resection necessary. This is distinct from 28119, which is reserved for spur excision with or without plantar fascial release. If the operative note describes removing a discrete spur, 28119 applies; if a segment of the calcaneus itself is resected, 28118 is correct. Miscoding between these two is a frequent audit flag.

The 90-day global period means all routine post-op foot care, dressing changes, and suture removal are bundled through day 90. Casting applied in the office during the post-op window can be billed separately only when it's necessitated by a new or unrelated clinical event — append modifier 24 on the associated E/M if you're documenting that encounter. Post-op complications requiring a return to the OR for a related procedure use modifier 78; an unrelated procedure in the global window uses modifier 79.

Site of service matters for 28118. The HOPD and ASC payment rates differ substantially (see the Site of Service comparison table). Payers — including Medicare — may scrutinize medical necessity when conservative treatment history is absent from the record, so documentation of failed non-surgical management is essential before going to the OR.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.98
Practice expense RVU	12.08
Malpractice RVU	0.86
Total RVU	18.92
Medicare national rate	$631.95
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	$631.95
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 28118 get rejected.

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

Wrong code selected: 28118 billed when the operative note describes spur-only excision, which maps to 28119.
Medical necessity denial when the record lacks documentation of failed conservative care prior to calcaneal resection.
Missing or inconsistent laterality between the CPT modifier (LT/RT) and the ICD-10 diagnosis code.
Bundling denial when concurrent soft tissue or wound debridement codes are submitted without a modifier establishing distinct procedural service.
Post-op cast application billed separately without modifier 24 on the E/M and supporting documentation that it was unrelated to routine global care.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What is the difference between CPT 28118 and 28119?

28119 is for excision of a discrete calcaneal spur, with or without plantar fascial release. 28118 applies when a portion of the calcaneus itself — not just a spur — is resected. The operative note must clearly describe what was removed; auditors flag notes that use both terms interchangeably.

02Can 28118 and 28119 be billed together on the same day?

Rarely justified. If the surgeon removes both a spur and a segment of the calcaneal body in the same session, the extent of work may support modifier 22 on 28118 with detailed documentation rather than billing both codes. Check current NCCI PTP edits before submitting both.

03Does the 90-day global period bundle post-op casting?

Routine casting as part of surgical closure is bundled. A cast applied in the office later during the global period because of swelling or a new clinical development can be billed separately — document the reason and append modifier 24 on the associated E/M service.

04Which modifiers are required for a unilateral procedure?

Always append LT or RT to identify side. If both feet are operated on in the same session, use modifier 50 instead and submit as a single line. Payers vary on whether they want modifier 50 on one line or LT/RT on two lines — verify your payer's preference before submitting.

05What ICD-10 codes most commonly support medical necessity for 28118?

Osteomyelitis of the calcaneus (M86 series), avascular necrosis (M87 series), and Haglund's deformity (M77.30) are the primary drivers. Make sure the ICD-10 code laterality matches the LT/RT modifier on the CPT code or expect an automatic mismatch denial.

06Is 28118 ever performed bilaterally in one session?

Bilateral calcaneal ostectomy in a single session is uncommon but not excluded. If performed, use modifier 50. The medical record must independently justify the bilateral indication — symmetric bilateral osteomyelitis, for example. Expect payer scrutiny and have the documentation ready.

Sources & references

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

Mira AI Scribe

The Mira AI Scribe captures the specific structure removed (calcaneal body segment vs. isolated spur), the surgical indication (osteomyelitis, necrosis, Haglund's deformity), laterality, and any concurrent procedures from dictation. This prevents the most common audit trigger for 28118: an operative note that says 'heel bone removed' without distinguishing the resection from a spur excision, which causes miscoding to 28119 or vice versa.

See how Mira captures CPT 28118 documentation