Partial excision of the talus or calcaneus using craterization, saucerization, sequestrectomy, or diaphysectomy techniques, performed for osteomyelitis or bony overgrowth (bossing).

Verified May 8, 2026 · 6 sources ↓

Medicare: $686.72
Total RVUs: 20.56
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCFindacodePayerpriceAacpm

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify the exact bone excised — talus or calcaneus — and which technique was used (craterization, saucerization, sequestrectomy, or diaphysectomy).
Document the clinical indication: osteomyelitis with culture/pathology findings, bossing/bony overgrowth, or other specific etiology.
Record laterality (left, right, or bilateral) in both the preoperative diagnosis and the body of the operative note.
Describe the extent of bone removed; vague language like 'partial excision performed' without anatomical detail invites downcoding or denial.
If debridement was also performed at the same site, document why it was a separately identifiable procedure at a distinct anatomical location.
For infection cases, include preoperative imaging, intraoperative findings describing necrotic or infected bone, and any specimen sent to pathology.

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 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 28120 covers partial bone removal from the talus or calcaneus using one of four surgical techniques: craterization (hollowing out a cavity), saucerization (creating a shallow dish-shaped defect), sequestrectomy (removing necrotic bone sequestra), or diaphysectomy (excising a segment of the bone shaft). The code applies to two distinct clinical indications — infection (typically osteomyelitis) and bony overgrowth (bossing). Both qualify; the operative note does not need to cite infection. Os trigonum excision from the talus also maps here.

The 90-day global period means all routine postoperative visits, wound checks, and dressing changes through day 90 are bundled into the surgical payment. Any separate E/M service for an unrelated problem during that window needs modifier 24. A new procedure for a related complication during the global period requires modifier 78; an unrelated procedure in the same window requires modifier 79.

Bundling watch: debridement codes 28003 and 28005 are NCCI-bundled with 28120 when performed at the same site. Hardware removal billed alongside calcaneal partial excision is payable separately only when the operative note clearly supports distinct, independent work. Distinguish 28120 from 28118 (complete calcaneal ostectomy) and 28119 (calcaneal spur excision with or without plantar fascia release) — technique and extent of bone removal drive the selection.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	7.13
Practice expense RVU	12.47
Malpractice RVU	0.96
Total RVU	20.56
Medicare national rate	$686.72
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	$686.72
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 28120 get rejected.

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

Operative note describes 'standard' or unspecified technique without naming craterization, saucerization, sequestrectomy, or diaphysectomy — auditors flag this and may recode to a lower-valued excision code.
Laterality missing or inconsistent between the claim, the operative report, and the diagnosis codes — common mismatch trigger for Medicare and commercial payers.
NCCI bundle violation when debridement codes 28003 or 28005 are billed same-site on the same date without modifier 59 or XS to establish a distinct anatomical location.
Medical necessity not supported: payer requests imaging or pathology confirming osteomyelitis or clinically significant bossing, and documentation contains only a verbal description.
Global period conflict: a follow-up E/M visit during the 90-day global billed without modifier 24, resulting in automatic denial of the office visit claim.

Frequently asked questions

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

01Does 28120 require an infection diagnosis to bill correctly?

No. The code covers both osteomyelitis and bony overgrowth (bossing). If the indication is bossing or another non-infectious cause, bill 28120 with the appropriate ICD-10 code for hypertrophy or structural abnormality of the talus or calcaneus.

02How does 28120 differ from 28118 and 28119?

28118 is a complete calcaneal ostectomy. 28119 is specifically a calcaneal spur excision with or without plantar fascia release. 28120 is for partial excision of the talus or calcaneus using craterization, saucerization, sequestrectomy, or diaphysectomy — technique and extent determine which code applies.

03Can os trigonum excision be billed as 28120?

Yes. Per CPT Assistant (October 2020), excision of the os trigonum of the talus is reportable with 28120.

04Can debridement codes 28003 or 28005 be billed on the same day as 28120?

Not at the same anatomical site — they are NCCI-bundled with 28120. If debridement was performed at a distinct, separate location, use modifier 59 or XS with supporting documentation that clearly establishes the separate site.

05What modifier do I use if the patient returns during the 90-day global for a wound complication requiring a return to the OR?

Use modifier 78 for an unplanned return to the OR for a complication related to the original procedure. Use modifier 79 only if the new procedure is entirely unrelated to the index surgery.

06Is 28120 billable bilaterally?

Yes, if both the talus or calcaneus on each side is treated during the same operative session, append modifier 50 (or LT and RT on separate lines per payer preference) and confirm the payer's bilateral payment policy, as some apply a 150% rule and others pay at 200%.

07What site of service should I use for 28120?

28120 is performed in an ASC (POS 24) or hospital outpatient department (POS 22). The payment rate differs between the two settings — see the Site of Service comparison on this page.

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 bone (talus vs. calcaneus), the surgical technique by name (craterization, saucerization, sequestrectomy, or diaphysectomy), the clinical indication (osteomyelitis or bossing), and laterality directly from dictation. That prevents the single most common audit flag for 28120 — operative notes that describe the outcome without naming the technique, which auditors use to recode or deny the claim.

See how Mira captures CPT 28120 documentation