Soft tissue repair · Foot & ankle
Radical resection of a bone tumor arising from a phalangeal bone of the toe, including wide excision of surrounding normal tissue margins.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $436.88
- Total RVUs
- 13.08
- 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 6 cited references ↓
- Operative note must name the specific phalanx resected and describe wide-margin excision technique, not just 'tumor removal'
- Preoperative imaging (MRI, CT, or plain films) documenting tumor location, size, and bony involvement
- Pathology report confirming tumor type and margin status — required to support the radical resection designation
- Indication clearly documented: malignant, aggressive benign, or locally destructive tumor requiring wide margins
- If performed during a 90-day global of a prior procedure, document medical necessity and use modifier 79 for unrelated or 78 for related return to OR
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 6 cited references ↓
CPT 28175 covers radical resection of a tumor involving a phalanx of the toe. Unlike simple excision, radical resection requires wide margins of normal tissue to be removed along with the tumor — the operative approach used for malignant or aggressive lesions where leaving any residual disease is unacceptable. The 90-day global period means all routine postoperative care, wound checks, and dressing changes through day 90 are bundled. Any new problem or unrelated visit during that window requires modifier 24; a separately significant E/M on the day of surgery requires modifier 25.
The distinction between 28175 and neighboring phalanx codes (e.g., 28150 phalangectomy, 28153 condyle resection, 28160 hemiphalangectomy) turns entirely on the nature of the pathology and the extent of resection. If the operative note doesn't explicitly describe wide-margin tumor resection with the rationale for that approach, auditors will downcode to a simpler phalangectomy code. Pathology confirmation of the margin status is the key supporting document. Staging studies, tumor board notes, or oncology co-management records strengthen the record when malignancy is the indication.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 8.08 |
| Practice expense RVU | 4.32 |
| Malpractice RVU | 0.68 |
| Total RVU | 13.08 |
| Medicare national rate | $436.88 |
| 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 | $436.88 |
HOPD (APC 5112) Hospital outpatient department | $1,642.82 |
ASC (PI A2) Ambulatory surgical center (freestanding) | $872.87 |
Common denial reasons
The recurring reasons claims for CPT 28175 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Operative note describes simple excision or phalangectomy language without documenting wide margins — payer downcodes to 28150 or 28153
- Missing or delayed pathology report at time of claim submission, causing medical necessity denial
- Billing 28175 with other foot phalanx resection codes on the same toe without a modifier to establish distinct anatomical sites
- Lack of preoperative imaging documentation to support extent of bony tumor involvement
- Global period conflict when 28175 is billed within the postoperative window of a prior foot procedure without appropriate modifier 78 or 79
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What separates 28175 from 28150 (phalangectomy)?
02Does 28175 require a malignant tumor, or can it cover aggressive benign tumors?
03What modifier applies if the patient returns to the OR for a complication during the 90-day global?
04Can 28175 be billed with a toe amputation code on the same operative session?
05Is modifier 22 supportable for 28175?
06What ICD-10 codes typically pair with 28175?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02aapc.comhttps://www.aapc.com/codes/cpt-codes/28175
- 03cms.govhttps://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-procedure-procedure-ptp-edits
- 04cgsmedicare.comhttps://www.cgsmedicare.com/medicare_dynamic/j15/partb/ptpb/ptp.aspx
- 05aaos.orghttps://www.aaos.org/globalassets/quality-and-practice-resources/coding-and-reimbursement/resident-guide/resident-guide_modifiers.pdf
- 06forwardhealth.wi.govhttps://www.forwardhealth.wi.gov/wiportal/content/provider/maxFee/pdf/maxfee13_podiatry.pdf.spage
Mira AI Scribe
Mira's AI scribe captures the specific phalanx resected, the surgeon's intraoperative description of margin width, the tumor characteristics driving the radical approach, and any co-managing oncology or pathology findings from dictation. This prevents the most common audit flag for 28175: an operative note that reads like a simple phalangectomy when wide-margin tumor resection was actually performed.
See how Mira captures CPT 28175 documentation