Radical resection of a tumor arising from a metatarsal bone, removing the lesion along with a margin of surrounding normal tissue to achieve clear margins.

Verified May 8, 2026 · 6 sources ↓

Medicare: $665.68
Work RVU: 13.81
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCFindacodeGenhealthEmedny

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) were resected (1st through 5th) and laterality (left or right foot)
Describe the surgical approach, incision location, and method of tumor exposure
Document the extent of resection including margin of normal tissue excised and whether periosteum or entire bone segment was removed
Record whether bone graft, synthetic graft, or internal fixation was used for reconstruction and why
Include pre-operative imaging (MRI, CT, or plain film) identifying the lesion and supporting the need for radical resection
Pathology report or intraoperative frozen section findings confirming tumor type (benign vs. malignant) and margin status
ICD-10 diagnosis code supported by biopsy or imaging — distinguish primary bone tumor, metastatic lesion, or benign aggressive lesion

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 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 28173 describes radical resection of a metatarsal tumor — an open procedure involving surgical exposure of the affected metatarsal, excision of the tumor with wide normal-tissue margins, and closure with or without bone grafting depending on the extent of bone removed. The "radical" designation distinguishes this from simple excision: the surgeon removes a cuff of normal tissue around the lesion, a technique standard for malignant tumors but also used for aggressive benign lesions when clean margins are essential.

The procedure carries a 90-day global period. All routine post-operative visits, wound checks, and dressing changes through day 90 are bundled — bill an unrelated E&M or procedure in that window with modifier 24 or 79, respectively. Reconstruction with bone graft or internal fixation at the same session may support modifier 22 if the work substantially exceeds the typical radical resection, but document the added intraoperative time, complexity, and reconstruction method explicitly.

Laterality matters: append LT or RT on every claim. If bilateral metatarsal resections are performed at the same session (rare), use modifier 50. When multiple metatarsals on the same foot are resected simultaneously, report 28173 for the primary and append modifier 51 for additional units — though payers vary on whether they reimburse multiple units separately or bundle them, so verify contract terms before assuming full reimbursement.

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 (13.81) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (19.93) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	13.81
Practice expense RVU	4.93
Malpractice RVU	1.19
Total RVU	19.93
Medicare national rate	$665.68
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	$665.68
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 28173 get rejected.

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

Missing laterality — claim rejected when LT or RT modifier is absent on facility or professional claim
Diagnosis-procedure mismatch — soft tissue or skin tumor ICD-10 codes paired with a bone resection CPT trigger medical necessity edits
Bundling into a more complex foot reconstruction code when resection was performed as part of a larger procedure without modifier 59 or XS documenting distinct service
Global period conflict — post-op visit billed without modifier 24 during the 90-day global window
Insufficient documentation of radical versus simple excision — operative note must establish wide-margin intent; notes describing only "removal of mass" are routinely downcoded

Frequently asked questions

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

01What is the global period for CPT 28173?

90 days. The day-before visit, the surgery day, and all routine post-op care through day 90 are bundled. Bill unrelated services in that window with modifier 24 (E&M) or 79 (unrelated procedure).

02When is modifier 22 appropriate with 28173?

When reconstruction — such as structural bone grafting or internal fixation — substantially increases operative work beyond a standard radical resection. Document additional intraoperative time and complexity explicitly; without it, the modifier 22 claim will be denied or ignored.

03Can 28173 and 28171 (tarsal radical resection) be billed together?

Yes, if tumors in distinct anatomic sites (a metatarsal and a tarsal bone) are resected at the same session. Append modifier 51 to the lower-valued code and ensure the operative note addresses both sites separately. Contiguous or overlapping resections are harder to support as distinct.

04Does 28173 require a pathology report to bill?

Payers don't mandate it on the claim itself, but medical necessity for radical resection is nearly impossible to defend at audit without a pre-op biopsy or intraoperative pathology result. Submit the operative note with a documented plan referencing the tumor diagnosis.

05Is 28173 appropriate for metastatic lesions in a metatarsal?

Yes, if radical resection with wide margins is performed. Use an ICD-10 code for secondary malignant neoplasm of bone (C79.51 or site-specific equivalent) and ensure the operative note addresses the clinical rationale for radical versus palliative resection.

06What is the site-of-service payment difference for 28173?

HOPD and ASC payments differ substantially — see the site-of-service comparison table on this page. The professional fee component is separate from facility payment and applies regardless of setting.

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, margin width, reconstruction method, and whether the resection was performed for a malignant or benign-aggressive lesion — the exact details auditors and payers require to support radical versus simple excision. That prevents the most common downcode: an operative note that describes tumor removal without documenting the wide-margin technique that justifies 28173 over a lesser excision code.

See how Mira captures CPT 28173 documentation