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
Work RVU: 8.08
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCCgsmedicareAAOSForwardhealth

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

22 Increased complexity 51 Multiple procedures 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

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 vs. total RVU

The work RVU (8.08) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (13.08) adds practice overhead and malpractice, and is what drives the Medicare payment below.

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)?

28150 is removal of a phalanx — often for deformity correction. 28175 requires radical resection of a tumor with wide normal-tissue margins. The pathology, the extent of resection, and the operative rationale must all point to tumor as the indication. Using 28150 when a malignant or aggressive tumor drove a wide-margin resection is an undercoding error.

02Does 28175 require a malignant tumor, or can it cover aggressive benign tumors?

Radical resection is appropriate for malignant tumors and for aggressive benign lesions where wide margins are clinically necessary to prevent recurrence — such as giant cell tumor or aneurysmal bone cyst. Document the clinical reasoning explicitly; 'benign' alone won't justify a radical approach without that rationale.

03What modifier applies if the patient returns to the OR for a complication during the 90-day global?

Modifier 78 applies when the patient returns to the OR for a procedure related to the original surgery during the global period. Modifier 79 applies for an unrelated procedure in the global window. Do not use 58 for a complication return — 58 is for planned staged procedures.

04Can 28175 be billed with a toe amputation code on the same operative session?

Only if performed on different toes with distinct clinical indications. If the amputation is performed on the same toe as part of the same tumor resection, they are not separately reportable. Append modifier 59 if billing for genuinely separate and distinct procedures on different digits, and document the anatomical distinction clearly in the operative note.

05Is modifier 22 supportable for 28175?

Yes, when operative complexity substantially exceeds the typical radical resection — for example, extensive soft-tissue involvement requiring reconstruction, prior surgery creating a hostile field, or neurovascular proximity requiring unusual dissection. The operative note must quantify the additional time and describe what made the case atypically difficult. Without that documentation, modifier 22 will be denied.

06What ICD-10 codes typically pair with 28175?

Malignant primary bone tumors (C40.3x for long bones of toe), secondary malignant neoplasm of bone (C79.51), and aggressive benign bone tumors (D16.3x for short bones of foot) are the most common pairings. The diagnosis code must reflect the pathology driving the radical approach — a benign cyst code won't support radical resection medical necessity.

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 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