Partial excision of a tarsal or metatarsal bone — including craterization, saucerization, sequestrectomy, or diaphysectomy — excluding the talus and calcaneus.

Verified May 8, 2026 · 7 sources ↓

Medicare: $599.21
Total RVUs: 17.94
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPC

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Name the specific technique performed: craterization, saucerization, sequestrectomy, or diaphysectomy — 'partial excision' alone is insufficient.
Identify the exact bone(s) involved by name and confirm they are tarsal or metatarsal (not talus, calcaneus, or phalanges).
Document the indication: osteomyelitis, bony prominence, avascular necrosis, or other pathology requiring partial bone removal.
Record the extent of resection and confirm that viable bone margins were achieved, especially when osteomyelitis is the diagnosis.
If performed during a diabetic foot infection encounter, document that the partial excision is a distinct procedure from any concurrent debridement or incision and drainage.

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 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 7 cited references ↓

CPT 28122 covers surgical partial removal of a tarsal or metatarsal bone (talus and calcaneus excluded). The procedure addresses pathology such as osteomyelitis, bony prominences (bossing), or necrotic bone requiring debridement down to viable tissue. Technique variants captured under this code include craterization, saucerization, sequestrectomy, and diaphysectomy — the specific technique performed must be named in the operative note.

The 90-day global period means all routine post-op care through day 90 is bundled. Any E/M visit, wound check, or dressing change within that window needs modifier 24 (unrelated E/M) or 78 (unplanned return to OR for related complication). Debridement codes 28003 and 28005 are NCCI-bundled with 28122; the incision required to reach the bone is integral to the partial excision and cannot be unbilled separately even with modifier 59.

Site-of-service selection matters here: HOPD and ASC payments differ substantially (see the Site of Service comparison table). Laterality modifiers LT and RT are appropriate; T-modifiers (toe designators) are not — the metatarsal is not a toe. If the procedure is performed bilaterally on the same date, use modifier 50.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.59
Practice expense RVU	10.6
Malpractice RVU	0.75
Total RVU	17.94
Medicare national rate	$599.21
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	$599.21
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 28122 get rejected.

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

T-modifier appended instead of LT/RT — T modifiers designate toes, not metatarsals or tarsals, and trigger modifier-mismatch denials.
NCCI bundle conflict when 28003 or 28005 (incision/drainage) is billed same-day without recognizing that the surgical approach is integral to 28122.
Missing or vague operative note — documentation that only states 'partial bone excision' without naming the technique or specific bone fails audit review.
Incorrect code selection when the procedure involves the talus or calcaneus, which are specifically excluded and require separate codes (e.g., 28118 for partial calcaneal ostectomy).
Global period violation — E/M or wound care billed within the 90-day global without modifier 24 or 25 on a same-day separate E/M.

Frequently asked questions

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

01Can I bill 28122 with 28003 or 28005 on the same day?

No. NCCI bundles 28003 and 28005 with 28122. The incision required to access the bone is integral to the partial excision. Modifier 59 does not override this edit when the incision is the same surgical approach.

02Which T-modifier should I use with 28122?

None. T-modifiers designate individual toes. CPT 28122 applies to tarsal and metatarsal bones. Use LT or RT for laterality. Appending a T-modifier is a documented denial trigger for this code.

03Does 28122 cover partial excision of the calcaneus or talus?

No. The talus and calcaneus are explicitly excluded. Partial calcaneal ostectomy is reported with 28118. Procedures on the talus require a different code selection.

04What modifier applies if the patient returns to the OR for wound dehiscence within the 90-day global?

Modifier 78 — unplanned return to the operating room for a complication related to the original procedure. Do not use 79, which is reserved for unrelated procedures during the post-op period.

05Can 28122 be billed bilaterally on the same date?

Yes, if partial excision is performed on both feet at the same operative session. Append modifier 50 and verify the payer accepts bilateral billing on a single line; some payers require two lines with LT and RT instead.

06Is an E/M billable on the same day as 28122?

Only if it is a separately identifiable, medically necessary service unrelated to the decision to operate. Append modifier 25 to the E/M. Within the 90-day global post-op period, use modifier 24 for unrelated E/M visits.

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 technique name (craterization, saucerization, sequestrectomy, or diaphysectomy), the specific tarsal or metatarsal bone resected, the clinical indication, and confirmation that talus and calcaneus were not involved. It also flags laterality for LT/RT assignment and distinguishes the partial excision from any concurrent debridement. This prevents the two most common denials: vague operative documentation and T-modifier misuse on a metatarsal-level procedure.

See how Mira captures CPT 28122 documentation