Surgical excision of one or more metatarsal bones of the foot, performed for fracture, tumor, infection, or severe structural deformity.

Verified May 8, 2026 · 6 sources ↓

Medicare: $561.80
Work RVU: 6.96
Global, days: 90
Region: Foot & ankle

Drawn from CMSMdclarityAAPCEmednyAacpm

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify which metatarsal(s) removed (1st through 5th) and laterality (left/right).
Document the indication: fracture, tumor, osteomyelitis, deformity, or other pathology requiring complete excision rather than partial.
Operative note must state why partial excision (28122) was insufficient or not attempted.
Record the surgical approach, dissection planes, joint disarticulation technique, and method of wound closure.
If concurrent procedures were performed on the same foot, document each as a distinct service with separate incision or anatomic site.
Pathology specimen disposition: note whether bone was sent for pathologic evaluation, particularly when tumor or infection is the indication.

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 LT Left side RT Right side 50 Bilateral procedure 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 28140 (metatarsectomy) covers complete surgical removal of a metatarsal bone. It applies when partial excision (28122) is insufficient — typically when disease, tumor, osteomyelitis, or structural failure has compromised the entire bone. The surgeon incises the dorsum of the foot, dissects to the metatarsal, disarticulates the proximal and distal joints, and extracts the bone. If only the metatarsal head is removed, codes 28111–28113 apply instead; 28140 requires excision of the full metatarsal shaft.

Distinguish 28140 from adjacent codes carefully. Ray resection (28810) includes the corresponding toe and metatarsal together and is not interchangeable. Transmetatarsal amputation (28805) removes all metatarsals distal to a transverse plane. When the metatarsal is involved in a bone tumor requiring wide oncologic margins, 28173 (radical resection, metatarsal) is the correct code, not 28140.

28140 carries a 90-day global period. Pre-op visits the day before surgery and all routine post-op care through day 90 are bundled. Separate E/M visits in that window require modifier 24 (unrelated) or 25 (separate significant decision). If same-day procedures on the same foot are medically necessary, modifier 59 separates distinct services; use anatomic modifiers LT/RT to identify laterality on every claim.

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 (6.96) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (16.82) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	6.96
Practice expense RVU	8.97
Malpractice RVU	0.89
Total RVU	16.82
Medicare national rate	$561.80
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	$561.80
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 28140 get rejected.

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

Wrong code selected — payer downcodes to 28122 (partial excision) when operative note describes only partial removal of the metatarsal.
Missing laterality — claims without LT or RT modifier are rejected by many payers and MACs.
Bundling with 28810 (ray resection) — if the toe was also removed in the same session, 28810 replaces 28140, not supplements it.
Lack of medical necessity documentation — diagnosis codes for mild deformity or elective cosmetic correction do not support metatarsectomy.
Global period violation — post-op E/M visits billed without modifier 24 or 25 are denied as included in the 90-day global.

Frequently asked questions

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

01What is the difference between 28140 and 28122?

28122 is partial excision (craterization, saucerization, sequestrectomy) of a metatarsal — think bone debridement for osteomyelitis. 28140 is complete removal of the metatarsal. If your operative note describes anything less than full excision, 28140 will be downcoded or denied.

02Should I bill 28140 or 28810 when removing a metatarsal and its corresponding toe together?

Bill 28810 (ray resection), which includes both the toe and the metatarsal as a single unit. 28140 describes metatarsal removal only; billing both 28140 and 28810 for the same ray creates an NCCI bundling conflict.

03Can 28140 be billed bilaterally with modifier 50?

Yes, if metatarsals on both feet are removed in the same operative session, modifier 50 applies. Alternatively, bill two line items with LT and RT. Confirm your payer's preference — some MACs require separate lines; others require modifier 50 on a single line.

04How do I bill if multiple metatarsals on the same foot are removed in one session?

Bill 28140 for each metatarsal removed, appending modifier 51 (multiple procedures) to the additional units and using the same laterality modifier (LT or RT) on each line. Some payers will reduce payment on the additional units per their multiple-procedure reduction policy.

05When does 28173 apply instead of 28140?

28173 (radical resection of tumor, metatarsal) applies when the surgical goal is wide oncologic margins around a malignant or aggressive tumor. 28140 is for excision due to fracture, deformity, or infection where en-bloc tumor margins are not the operative objective. Mixing the two based on ICD-10 diagnosis alone is an audit flag.

06Is a return to the OR within the 90-day global period billable?

Yes, with the right modifier. An unplanned return to the OR for a complication related to the original metatarsectomy uses modifier 78. An unrelated procedure during the global period uses modifier 79. Neither bypasses the global — both reduce payment to reflect only the new intraoperative work.

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 metatarsal number, laterality, surgical approach, joint disarticulation technique, and the clinical rationale for complete rather than partial excision. That detail prevents downcoding to 28122 and supports medical necessity when payers audit 28140 claims against submitted diagnosis codes.

See how Mira captures CPT 28140 documentation