Delayed repair of a foot flexor tendon using a free graft harvested from a separate donor site; reported per tendon repaired and includes graft procurement.

Verified May 8, 2026 · 5 sources ↓

Medicare: $608.56
Total RVUs: 18.22
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCFindacodeAAOS

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 tendon(s) repaired by name and anatomical location in the operative note.
Confirm the repair is delayed/secondary rather than primary — document the interval from original injury.
Describe the graft donor site, type of graft (tendon, other), and harvest technique.
State the surgical approach and level of tendon disruption found at exploration.
If billing multiple units, document each distinct tendon as a separately identifiable structure.
Record any complicating factors (scarring, adhesion, altered tissue planes) to support modifier 22 if work substantially exceeded typical.

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 25 Significant separate E/M 50 Bilateral procedure 51 Multiple procedures 57 Decision for surgery 58 Staged or related 59 Distinct service 73 Discontinued pre-anesthesia 74 Discontinued post-anesthesia 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 28202 covers a delayed (secondary) repair of a ruptured or torn flexor tendon in the foot, performed using a free graft obtained from another anatomical location. The code bundles graft harvest into the repair — do not separately report graft procurement. It is reported per tendon, so if two distinct flexor tendons are repaired at the same operative session, the code can be reported twice with modifier 59 appended to the second unit to distinguish the separate tendons.

The 90-day global period means all routine follow-up, wound care, and postoperative evaluation through day 90 are bundled. Modifier 24 is required for an E/M addressing an unrelated problem in that window; modifier 78 applies if the patient returns to the OR for an unplanned procedure related to the original repair. Modifier 58 applies to a staged procedure planned from the outset — document that intent in the original operative note.

Site of service affects physician payment. The procedure is performed primarily in a hospital outpatient or ASC setting; physician work RVUs remain constant, but practice expense RVUs are reduced under the facility rate. See the Site of Service comparison table for the specific differential.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.89
Practice expense RVU	10.58
Malpractice RVU	0.75
Total RVU	18.22
Medicare national rate	$608.56
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	$608.56
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,895.55

Common denial reasons

The recurring reasons claims for CPT 28202 get rejected.

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

Graft harvest billed separately — it is bundled into 28202 and will deny as a component procedure.
Primary tendon repair coded as 28202 — this code is for delayed/secondary repair with graft; primary repair has its own code.
Multiple units submitted without modifier 59 on additional tendons, triggering an MUE edit.
Missing documentation of graft donor site, causing medical necessity queries and payer downcoding.
E/M billed during the 90-day global for a related issue without modifier 24, resulting in global period bundling denial.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Is graft harvest separately billable with 28202?

No. Graft procurement is bundled into 28202. Billing a separate harvest code with this procedure will deny under NCCI edits.

02Can 28202 be reported more than once in a single session?

Yes — the code is reported per tendon repaired. Append modifier 59 to the second and subsequent units to identify each as a distinct tendon repair, and document each tendon separately in the operative note.

03What distinguishes 28202 from a primary tendon repair code?

28202 is specifically a delayed (secondary) repair requiring a free graft. Primary tendon repairs performed acutely map to different codes. Using 28202 for a primary repair will invite a medical necessity denial if the operative note shows an acute, same-setting repair without graft.

04When does modifier 22 apply to 28202?

Use modifier 22 when operative complexity substantially exceeds the typical repair — for example, extensive tendon scarring, prior failed repair, or severely altered tissue planes requiring significantly more work. The operative note must describe the specific findings and quantify the extra time or effort; a generic statement is insufficient.

05How does the 90-day global period affect post-op billing?

All routine post-operative care through day 90 is bundled. E/M visits for unrelated conditions require modifier 24. A return to the OR for a complication related to the repair requires modifier 78. A planned staged procedure requires modifier 58 — document the staging intent in the original operative note.

06Does site of service affect reimbursement for 28202?

Yes. Physician payment is reduced when the procedure is performed in a facility (HOPD or ASC) versus a non-facility setting because practice expense RVUs are lower in the facility rate. See the Site of Service comparison on this page for the specific values.

Sources & references

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

Mira AI Scribe

The Mira AI Scribe captures the specific tendon name and anatomical location, the delayed-repair indication with time elapsed since injury, graft donor site and harvest description, and any complicating factors such as scarring or adhesion noted intraoperatively. That documentation prevents the two most common audit flags: miscoding a primary repair as 28202, and denials for missing graft-harvest detail.

See how Mira captures CPT 28202 documentation