Surgical excision of the talus (astragalus) bone of the ankle to address pain, structural instability, or pathology affecting the ankle joint.

Verified May 8, 2026 · 5 sources ↓

Medicare: $598.88
Work RVU: 9.26
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCMdclarityAoassn

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

State the specific bone being excised — talus (astragalus) — by anatomic name in the operative report title and body.
Document the clinical indication (e.g., avascular necrosis, bone tumor, post-traumatic arthritis, infection) with supporting imaging or pathology references.
Record laterality explicitly (left, right, or bilateral) in both the operative report and the pre-operative diagnosis.
Describe the surgical approach, incision location, and extent of bone removal — notes that say 'talus excised per plan' without anatomic detail invite audit.
Include intraoperative findings confirming the non-viability or pathology of the talus to support medical necessity.
Document any concurrent procedures separately with distinct descriptions if additional codes are billed.

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 62 Co-surgeons 74 Discontinued post-anesthesia 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 28130 covers complete surgical removal of the talus — the bone that sits between the heel and the lower leg bones forming the primary weight-bearing joint of the ankle. Indications include avascular necrosis, severe arthritis, bone tumors, or post-traumatic collapse where the talus is no longer viable and reconstruction is not feasible. The procedure is typically performed to stabilize the ankle and relieve pain when other interventions have failed.

Talectomy carries a 90-day global period. That means the operative day, any day-before visit, and all routine post-op care through day 90 are bundled into the payment. Bill unrelated E/M services in the global window with modifier 24. If a staged procedure — such as a subsequent tibiocalcaneal fusion — is planned after the talectomy, append modifier 58 to the fusion code. An unrelated procedure in the global period takes modifier 79.

Document laterality explicitly — left, right, or bilateral. Use modifiers LT or RT on every claim. If bilateral talectomies are performed in the same session (exceedingly rare but possible in certain deformity or tumor cases), append modifier 50 and verify payer-specific bilateral payment rules, as some payers apply the 150% bilateral reduction automatically.

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 (9.26) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (17.93) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	9.26
Practice expense RVU	7.28
Malpractice RVU	1.39
Total RVU	17.93
Medicare national rate	$598.88
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	$598.88
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,988.50

Common denial reasons

The recurring reasons claims for CPT 28130 get rejected.

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

Missing or ambiguous laterality — claim submitted without LT/RT modifier or the operative note and claim don't match.
Medical necessity not established — no supporting imaging, prior conservative treatment documentation, or pathology report linked to the diagnosis code.
Bundling conflict when concurrent procedures are billed without appropriate modifier 59 or XS to establish distinct procedural service.
Diagnosis code mismatch — ICD-10 code submitted does not map to talus pathology, triggering automatic rejection.
Global period violation — post-op E/M visits billed without modifier 24 during the 90-day global window.

Frequently asked questions

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

01Is 28130 ever performed bilaterally, and how do I bill it?

Bilateral talectomy is rare but possible in bilateral avascular necrosis or systemic conditions. If performed in the same session, append modifier 50 and confirm the payer's bilateral reduction policy — many apply a 150% of single-procedure rate cap automatically.

02What modifier do I use if tibiocalcaneal fusion is planned after this talectomy?

Append modifier 58 to the fusion code when billed. It signals a staged or related procedure by the same surgeon during the global period of 28130, which overrides the global bundling and allows separate reimbursement.

03Does the 90-day global period mean I can't bill any E/M visits post-op?

You can bill post-op E/M visits that address problems unrelated to the talectomy — use modifier 24 on those claims. Routine wound checks, dressing changes, and follow-up directly related to the surgery are bundled into the global and are not separately billable.

04What ICD-10 codes typically support medical necessity for 28130?

Avascular necrosis of the talus (M87.071/M87.072), post-traumatic arthritis of the ankle (M19.171/M19.172), bone tumors, and osteomyelitis of the ankle are common supporting diagnoses. The ICD-10 code must specifically reference the talus or ankle region — a generic foot pain code will not establish necessity.

05Can 28130 be performed in an ASC, and does the site of service affect reimbursement?

Yes, 28130 is payable in an ASC. The ASC payment rate differs from the HOPD rate — see the Site of Service comparison on this page. The physician's professional fee RVU-based payment does not change by site of service, but the facility component does.

06Is modifier 22 ever appropriate for 28130?

Modifier 22 applies when the work is substantially greater than typical — for example, a talectomy complicated by prior hardware removal, extensive scarring from prior infection, or tumor involvement requiring wider resection. Document the additional time, complexity, and intraoperative findings explicitly; without that documentation, payers will deny the upcharge.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the bone name (talus/astragalus), laterality, surgical approach, intraoperative findings confirming pathology, and any concurrent procedures from the surgeon's dictation — populating the operative note with the anatomic specificity auditors look for. This prevents the most common 28130 denial trigger: a vague operative note that fails to establish medical necessity or confirm which bone was excised.

See how Mira captures CPT 28130 documentation