Surgical resection of condyle(s) at the distal end of a toe phalanx, resulting in partial toe removal

Verified May 8, 2026 · 6 sources ↓

Medicare: $398.47
Work RVU: 3.71
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCMdclarityPodiatrymAacpm

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify the specific toe(s) and laterality (LT/RT) in the operative note
Name the anatomic target explicitly — condyle(s) of the distal phalanx — not generic 'partial toe removal'
Document the clinical indication driving resection (e.g., hammertoe deformity, infected ulcer, bony prominence with skin breakdown)
Describe the surgical approach and extent of bone removed, distinguishing condylar resection from hemiphalangectomy or full phalangectomy
Record any concurrent procedures performed at the same session with separate operative descriptions to support multi-procedure billing

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 52 Reduced services 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 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 6 cited references ↓

CPT 28153 covers resection of the condyle(s) from the distal phalanx of a toe, a procedure most commonly performed by podiatrists for conditions including hammertoe deformity, infection, ulceration, or bony prominence causing pain or skin breakdown. The condylar resection reduces the bony mass at the toe tip and is distinct from a full phalangectomy (28150), hemiphalangectomy (28160), or partial phalanx excision (28124), all of which target different anatomic segments of the phalanx.

This code carries a 90-day global period. Routine follow-up wound care, dressing changes, and suture removal in that window are included — bill separately only for unrelated E/M visits (modifier 24) or clearly distinct new problems (modifier 25). When the same surgeon performs a subsequent related procedure during the global — say, debridement of a wound complication — append modifier 78. An unrelated procedure in the same global window takes modifier 79.

Differentiating 28153 from its neighbors is the most common coding challenge. The operative note must specify that the resection targeted the condyle(s) of the distal phalanx, not the proximal end of the phalanx (28126) or the entire phalanx (28150). Audit teams flag notes that describe the anatomic site vaguely or borrow language from a hammertoe correction (28285) when a condylar resection was actually performed.

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 (3.71) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (11.93) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	3.71
Practice expense RVU	7.86
Malpractice RVU	0.36
Total RVU	11.93
Medicare national rate	$398.47
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	$398.47
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 28153 get rejected.

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

Operative note describes 'partial phalanx excision' without specifying condyle — payer downcodes or denies for insufficient specificity
Billed concurrently with 28285 (hammertoe correction) without modifier 59 or XS when a separate, distinct condylar resection was performed
Global period conflict — post-op visit billed without modifier 24 when unrelated to the toe procedure
Laterality missing or conflicting between claim and operative note, triggering front-end edit rejection
Medical necessity not supported — no documented diagnosis (e.g., no ICD-10 for deformity, ulceration, or infection) linked to the resected toe

Frequently asked questions

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

01How does 28153 differ from 28150, 28160, and 28124?

28150 is full phalangectomy of a toe. 28160 is hemiphalangectomy (proximal half). 28124 is partial excision of the phalanx body. 28153 specifically targets the condyle(s) at the distal end of the phalanx. The operative note must make that distinction explicit — the same incision can produce four different correct codes depending on what bone was actually removed.

02Can 28153 and 28285 be billed together?

Only if the condylar resection was performed as a genuinely separate procedure on a different anatomic site from the hammertoe correction. Append modifier 59 or XS to 28153 and document distinct operative steps. If the condylar resection was part of the hammertoe repair, 28285 alone is correct.

03What modifier applies when a patient returns during the 90-day global for a wound complication requiring debridement?

Modifier 78 — unplanned return to the OR for a procedure related to the original surgery. Do not use modifier 79, which is for unrelated procedures in the global window.

04Is modifier 50 appropriate for bilateral condylar resections on the same toe of each foot?

Yes, if the same condylar resection is performed on mirror-image toes bilaterally in the same session, modifier 50 applies. Document both sides in the operative note. Some payers require LT and RT on separate lines instead of modifier 50 — verify payer preference before submitting.

05What ICD-10 codes most commonly support medical necessity for 28153?

Hammertoe deformity codes (M20.4x), acquired toe deformities, chronic ulceration with underlying bony involvement, and osteomyelitis of the toe are the primary drivers. The diagnosis must link specifically to the toe and laterality billed. A generic 'foot pain' code is insufficient and will likely trigger a medical necessity denial.

06Does the site of service affect payment for 28153?

Yes. HOPD and ASC payments differ — see the Site of Service comparison on this page. The 90-day global period applies regardless of setting. Confirm whether your ASC contract follows Medicare's published ASC rate or a negotiated multiplier.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the specific anatomic target (condyle of distal phalanx), the toe number, and laterality directly from dictation, and flags when the operative description overlaps with hammertoe correction language that could trigger a 28285 substitution. This prevents the most common audit flag for 28153: vague phalanx language that payers use to downcode or bundle the claim.

See how Mira captures CPT 28153 documentation