Surgical partial excision of a phalanx or other osseous structure of a toe, typically performed for infection, deformity, or bony prominence causing pain or skin breakdown.

Verified May 8, 2026 · 5 sources ↓

Medicare: $387.12
Work RVU: 3.55
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCMdclarityAAOS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify which toe and which phalanx (proximal, middle, or distal) was partially resected — 'partial phalangectomy, right second proximal phalanx' is the minimum acceptable level of specificity.
Document the underlying pathology (osteomyelitis, deformity, bony prominence, necrosis) with supporting clinical findings or imaging that justify surgical intervention.
Describe the surgical approach and extent of bone removed; avoid generic language like 'standard resection' — audit teams flag operative notes that don't quantify or describe the resection.
Record pre-op and post-op diagnoses, anesthesia type, and the names of all concurrent procedures performed during the same session.
If billing multiple toe procedures same-day, identify each digit by number and laterality in both the operative note and on the claim form.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 59 Distinct service 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 28126 covers the partial removal of a toe bone — most commonly a portion of a phalanx — to address infection (such as osteomyelitis), painful deformity, or a bony lesion that has failed conservative management. The procedure is distinct from complete phalangectomy codes (28124) and from condylectomy (28153); the operative note must make clear that a partial osseous resection was performed, not a soft-tissue-only procedure or a full-bone removal.

This code carries a 90-day global period. All routine postoperative visits, wound checks, and dressing changes through day 90 are bundled. Billing an E/M visit in that window for a related complaint requires modifier 24; a separately identifiable same-day E/M requires modifier 25. Unplanned return to the OR for a related complication within the global uses modifier 78; an unrelated procedure in the same period uses modifier 79.

Podiatry and orthopedic surgery are the predominant billing specialties for this code. When multiple toes are addressed in the same session, modifier 51 applies to additional procedures, and digit-specific modifiers (T-codes, or LT/RT when applicable) are expected by most payers to identify the operative toe and prevent claim-level ambiguity.

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 (3.55) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (11.59) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	3.55
Practice expense RVU	7.66
Malpractice RVU	0.38
Total RVU	11.59
Medicare national rate	$387.12
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	$387.12
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 28126 get rejected.

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

Wrong code selection — partial phalangectomy miscoded as condylectomy (28153) or complete phalangectomy (28124) when the operative note supports 28126.
Missing or non-specific digit identification; payers expect a toe-level modifier and will deny or suspend claims that list only 'foot' without identifying which toe was operated on.
Medical necessity not established — claims denied when the record lacks imaging, culture results, or clinical documentation showing failure of conservative treatment.
Global period violations — post-op E/M visits billed without modifier 24 when the visit is related to the surgical diagnosis.
Bundling conflicts when 28126 is billed alongside procedures that NCCI considers inclusive without an appropriate modifier to establish a distinct service.

Frequently asked questions

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

01What is the difference between 28126 and 28124?

28124 is complete removal of a phalanx; 28126 is partial removal. The operative note must confirm that bone was only partially resected to support 28126. If the entire phalanx was removed, 28124 is the correct code and upcoding to 28126 — or vice versa — is an audit risk.

02Do I need a digit modifier on every 28126 claim?

Yes. Most payers, including Medicare, require a toe-specific modifier (TA, T1–T9 for digits, or at minimum LT/RT) to identify the operative toe. Claims without digit identification are routinely suspended or denied for insufficient information.

03Can I bill 28126 and 28153 together for the same toe?

Generally not for the same toe at the same session — NCCI edits and forum guidance from AAPC indicate these codes overlap when the resection is at the same anatomic site. If the condylectomy and partial phalangectomy are clearly at distinct sites or distinct toes, modifier 59 may apply, but document the distinction explicitly.

04How does the 90-day global period affect follow-up billing?

All routine post-op care through day 90 is bundled into 28126. Append modifier 24 to an E/M billed in that window for an unrelated condition, or modifier 25 if a separately identifiable service occurs on the same day as a minor in-office procedure. A return to the OR for a related complication requires modifier 78.

05If I operate on two toes bilaterally in the same session, how do I bill?

Bill 28126 once for the primary toe, then report additional toe procedures with modifier 51 (multiple procedures) and append the appropriate digit or laterality modifier to each line. Modifier 50 applies only when the identical procedure is performed on the same-numbered toe on both feet simultaneously, which is uncommon for this code.

06When is modifier 22 appropriate for 28126?

Use modifier 22 when the procedure required substantially more work than typical — for example, severe infection with extensive debridement, dense scarring from prior surgery, or unusually complex anatomy. The operative note must narrate the additional complexity and time; attaching modifier 22 without supporting documentation will trigger a payer audit or denial.

Sources & references

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

01CMS Physician Fee Schedule 2026
02
aapc.com
https://www.aapc.com/codes/cpt-codes/28126
03
mdclarity.com
https://www.mdclarity.com/cpt-code/28126
04
cms.gov
https://www.cms.gov/medicare/regulations-guidance/physician-self-referral/list-cpt-hcpcs-codes
05
aaos.org
https://www.aaos.org/quality/coding-and-reimbursement/

Mira AI Scribe

Mira's AI scribe captures the operative dictation details that matter most for 28126: which toe, which phalanx, how much bone was removed, the stated pathology (infection, deformity, prominence), and any concurrent procedures performed in the same session. That specificity prevents the two most common denial triggers — non-specific digit documentation and wrong-code selection between 28126, 28124, and 28153.

See how Mira captures CPT 28126 documentation