Partial excision of phalangeal bone of a toe, including craterization, saucerization, sequestrectomy, or diaphysectomy techniques, typically performed for osteomyelitis or bony prominence.

Verified May 8, 2026 · 7 sources ↓

Medicare: $474.29
Work RVU: 4.88
Global, days: 90
Region: Foot & ankle

Drawn from CMSCgsmedicareAssociationdatabasePodiatrymAAPC

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify the exact toe and phalanx (e.g., proximal phalanx, fifth toe) — use T-modifier consistent with the operative note
Name the excision technique performed (craterization, saucerization, sequestrectomy, or diaphysectomy) — not just 'partial bone removal'
Document the indication: osteomyelitis with bone culture/pathology results, or bossing/exostosis with clinical description of prominence
Describe the extent of bone removal and confirm it was partial, not a hemiphalangectomy or full joint resection, to justify 28124 over 28160
If osteomyelitis, include imaging or intraoperative findings supporting infected/necrotic bone requiring excision
For same-day E/M billed with modifier 57, document the decision-for-surgery conversation as a distinct service

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 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

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 28124 covers partial removal of a toe's phalanx using bone-excision techniques — craterization, saucerization, sequestrectomy, or diaphysectomy. The most common indications are osteomyelitis with infected or necrotic bone and bony prominences (bossing) causing pain or deformity, such as a dorsal exostosis at the proximal interphalangeal joint in hammertoe correction. The procedure stops short of removing the entire phalanx or resecting the joint, which distinguishes it from hemiphalangectomy (28160). If the surgeon removes a portion of bone versus the proximal end of the phalanx or the full interphalangeal joint, 28124 is the correct code — not 28160.

The 90-day global period means all routine post-op visits, wound checks, and dressing changes through day 90 are bundled into the payment. Unrelated E/M services during that window require modifier 24. A decision-for-surgery E/M on the same date requires modifier 57. Return to the OR for a related complication uses modifier 78; an unrelated procedure in the global period uses modifier 79.

Toe-specific modifiers (TA, T1–T9) are required for Medicare claims. The MUE for many toe procedures is 1 per toe, so if the same procedure is performed on multiple toes in the same session, each toe gets its own line with the appropriate T-modifier. Do not stack modifier 50 for bilateral toe procedures — use separate lines with TA through T9 as applicable per NCCI Chapter 4 guidance.

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 (4.88) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (14.2) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	4.88
Practice expense RVU	8.85
Malpractice RVU	0.47
Total RVU	14.2
Medicare national rate	$474.29
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	$474.29
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI P3) Ambulatory surgical center (freestanding)	$297.07

Common denial reasons

The recurring reasons claims for CPT 28124 get rejected.

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

Missing or mismatched T-modifier — Medicare requires toe-specific modifiers and will deny without them
Upcoding or miscoding to 28160 (hemiphalangectomy) when operative note describes only partial bone excision without joint resection
E/M billed same-day without modifier 57, triggering global surgery bundle denial
Modifier 51 appended to secondary procedures where no NCCI bundle exists — unnecessary modifiers can flag claims for review
Insufficient documentation of osteomyelitis (no imaging, culture, or intraoperative description of necrotic bone) leading to medical necessity denial

Frequently asked questions

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

01What's the difference between 28124 and 28160?

28124 is a partial bone excision — some phalanx remains. 28160 (hemiphalangectomy) removes the proximal end of the phalanx or involves interphalangeal joint resection. If the operative note describes removing a bony prominence or debriding infected bone while leaving most of the phalanx intact, 28124 is correct. If the proximal end is removed or the joint is excised, use 28160.

02Which toe modifier is required for Medicare claims?

Use TA (left foot, great toe) through T9 (right foot, fifth toe) on every Medicare line for 28124. The NCCI Chapter 4 policy sets MUEs at 1 per toe based on these modifiers. Missing the T-modifier is a leading denial cause.

03Can 28124 be billed for multiple toes on the same day?

Yes. Bill a separate line for each toe with the corresponding T-modifier. Do not use modifier 50 for bilateral toe procedures — CMS requires separate line reporting with T-modifiers, not bilateral modifier, when the code descriptor does not define the procedure as bilateral.

04Is a same-day E/M separately billable with 28124?

Only with the right modifier. If the visit was solely to decide whether to perform the surgery, append modifier 57 to the E/M. Routine pre-op assessments on the same day as a 90-day global procedure are not separately payable. Post-op E/M visits for unrelated conditions during the global period require modifier 24.

05Can 28124 be billed with 28230 or 11750 on the same date?

Yes — there are no NCCI bundles between 28124, 28230, and 11750. Bill each with the appropriate site or toe modifier. Do not add modifier 51 or 59 when no bundle edit exists; those modifiers are unnecessary and can invite audit scrutiny.

06What ICD-10 diagnoses support 28124 for osteomyelitis?

Acute or chronic osteomyelitis codes in the M86.x series (specify bone and laterality) are the primary support. For bossing or exostosis, M92.7x (juvenile osteochondrosis of tarsus/metatarsus) or M89.37x (hypertrophy of bone, ankle and foot) apply. Match the ICD-10 code to the laterality and toe documented in the operative note.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the excision technique by name (craterization, saucerization, sequestrectomy, or diaphysectomy), the specific toe and phalanx treated, and the clinical indication — osteomyelitis with intraoperative bone findings or bossing description. It also flags the T-modifier required for that toe. This prevents the two most common audit triggers: operative notes that omit technique specificity and claims submitted without the correct toe-level modifier.

See how Mira captures CPT 28124 documentation