Soft tissue repair · Foot & ankle
Surgical removal of a portion of a toe's phalanx or interphalangeal joint, performed for trauma, infection, tumor, or structural deformity.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $406.82
- Work RVU
- 3.78
- Global, days
- 90
- Region
- Foot & ankle
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 5 cited references ↓
- Identify the specific toe(s) involved by name or number and laterality (left/right foot).
- Document the clinical indication — infection, trauma, tumor, or structural deformity — with supporting imaging or lab findings where applicable.
- Specify the anatomical level of resection: proximal phalanx end or interphalangeal joint excision.
- Operative note must distinguish the extent of bony removal to support 28160 versus adjacent codes (28124, 28126, 28150, 28153).
- Record the surgical approach, instrumentation used, and wound closure technique.
- If multiple toes are addressed, document each toe separately; the code is reported per toe.
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 5 cited references ↓
CPT 28160 covers hemiphalangectomy or interphalangeal joint excision of a toe — specifically the proximal end of the phalanx. Indications include osteomyelitis, traumatic injury, tumor involvement, or deformity that cannot be addressed by lesser procedures. The code applies per toe operated on, meaning laterality and toe identification matter for both documentation and modifier selection.
The 90-day global period encompasses all routine follow-up. Any E/M visit during that window tied to the procedure is bundled. If you're seeing the patient for a genuinely unrelated problem during the global, append modifier 24. A staged revision or related return to the OR within the global takes modifier 78; an unrelated OR procedure takes modifier 79.
Disambiguating 28160 from nearby codes is the most common coding challenge. Use 28150 for complete phalangectomy of a toe, 28124 for partial bone excision due to osteomyelitis or bossing, 28126 for resection of the phalangeal base, and 28153 for condyle resection at the distal phalanx end. 28160 is specifically for the proximal end of the phalanx or the interphalangeal joint itself. Conflating these codes triggers downcoding or medical necessity denials.
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 (3.78) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (12.18) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 3.78 |
| Practice expense RVU | 8.01 |
| Malpractice RVU | 0.39 |
| Total RVU | 12.18 |
| Medicare national rate | $406.82 |
| 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 | $406.82 |
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 28160 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Wrong code level selected — payers downcode to 28124 or 28126 when operative notes don't explicitly describe proximal phalanx or interphalangeal joint resection.
- Missing laterality — claims without LT or RT modifier are rejected by many payers as incomplete.
- Medical necessity not established — insufficient documentation of failed conservative treatment or severity of infection/structural compromise.
- Bundling conflict when 28160 is billed same-day with overlapping digit codes without a supported modifier 59 or XS to establish distinct anatomy.
- Global period violation — E/M services billed during the 90-day global without modifier 24 to indicate an unrelated visit.
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01How does 28160 differ from 28150?
02Can 28160 be billed for multiple toes in the same session?
03Is modifier 50 appropriate for 28160?
04What happens to E/M visits during the 90-day global?
05Is 28160 the right code for hammertoe correction?
06Can 28160 be billed with 28289 (hallux rigidus cheilectomy) on the same day?
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 operative dictation elements that anchor 28160: the specific toe number, laterality, anatomical level of resection (proximal phalanx versus interphalangeal joint), the clinical indication, and the extent of bony removal. This prevents the most common audit flag — an operative note that doesn't distinguish proximal-end phalanx resection from condyle resection or complete phalangectomy, which triggers manual review and downcoding.
See how Mira captures CPT 28160 documentation