Surgical repair of an extensor tendon in the foot, primary or secondary, per tendon.

Verified May 8, 2026 · 6 sources ↓

Medicare: $498.34
Total RVUs: 14.92
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCAshlinkCgsmedicareFindacode

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 6 cited references ↓

Specify the tendon(s) by name and anatomical location (e.g., extensor hallucis longus, extensor digitorum longus to the second toe) — notes that say 'foot extensor tendon' without naming the structure flag on audit.
Document the repair type: primary (acute, direct end-to-end) or secondary (delayed or revision), since payers use this to confirm medical necessity and appropriate code selection.
Record the mechanism or etiology — traumatic rupture, spontaneous rupture, or tendon disorder — with corresponding ICD-10 and any conservative treatment attempted prior to surgery.
State the surgical approach and extent of repair including tendon condition found intraoperatively (gap size, tissue quality, any graft need) to support 28208 versus the graft variant 28210.
If billing multiple units (more than one tendon), the operative note must individually describe each tendon repaired in sufficient detail to support each billed unit.
Document laterality (left/right) to support LT or RT modifier; bilateral same-session repairs require modifier 50 with supporting documentation.

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 LT Left side RT Right side 50 Bilateral procedure 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon 24 Unrelated E/M during global 25 Significant separate E/M

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 28208 covers open surgical repair of an extensor foot tendon — primary (acute) or secondary (delayed or revision) — billed per tendon repaired. The code sits within the extensor tendon repair family alongside 28210, which adds a free graft. When multiple tendons are repaired in the same session, bill 28208 for each tendon with modifier 51 appended to the additional units.

The 90-day global period means all routine follow-up — wound checks, cast changes, suture removal, and standard post-op visits — is bundled through day 90. Anything unrelated to the tendon repair during that window needs modifier 24 (E/M) or 79 (unrelated procedure). A complication requiring a return to the OR for the same tendon gets modifier 78; a staged revision or planned second-stage procedure gets modifier 58.

Medical necessity hinges on linking the correct ICD-10: traumatic ruptures (S96.x, S86.x series), spontaneous ruptures not amenable to conservative care (M66.271–M66.279, M66.371–M66.379, M66.871–M66.879), and tendon disorders with documented failed conservative management. Payers including American Specialty Health explicitly require evidence that casting or bracing was either attempted or contraindicated before approving surgical repair.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	4.4
Practice expense RVU	9.96
Malpractice RVU	0.56
Total RVU	14.92
Medicare national rate	$498.34
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	$498.34
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 28208 get rejected.

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

Missing or non-specific ICD-10 linkage — payers deny when the diagnosis does not clearly indicate rupture or a disorder that failed conservative management.
Operative note lacks tendon-level specificity; generic language such as 'repaired extensor tendon' without identifying the individual tendon is a common audit and denial trigger.
Global period conflict — post-op services billed without modifier 24 or 79 during the 90-day global window are automatically bundled and denied.
Multiple-tendon billing without modifier 51 or without individual documentation of each tendon in the operative report; payers deny additional units absent supporting detail.
Upcoding concern when 28208 is billed but the operative note describes a procedure that included a free tendon graft, which maps to 28210 — results in downcoding or denial pending review.

Frequently asked questions

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

01What is the difference between 28208 and 28210?

28208 is for extensor tendon repair without a free graft — direct repair of the tendon end-to-end or with local tissue. 28210 is used when a free graft is harvested and incorporated into the repair. If your operative note documents graft harvest and use, 28210 is the correct code; billing 28208 in that scenario is a downcode.

02Can I bill 28208 more than once in the same session?

Yes. The code is billed per tendon repaired. Bill the primary tendon without a multiple-procedure modifier, and append modifier 51 to each additional tendon. Each tendon must be individually documented in the operative report — a single generic description will not support multiple units.

03Which ICD-10 codes support medical necessity for 28208?

Accepted diagnoses include traumatic ruptures (S96.x, S86.011A–S86.019S, S96.919A–S96.919S), spontaneous ruptures not amenable to conservative care (M66.271–M66.279, M66.371–M66.379, M66.871–M66.879), and certain tendon disorders (M65.x, M67.x, M71.x series). Document why casting or bracing was not appropriate if the rupture is spontaneous — several payers require that language explicitly.

04How does the 90-day global period affect billing for complications?

Return to the OR for a complication related to the original repair bills with modifier 78 — this is an unplanned return for a related problem. If the patient returns for a completely unrelated surgical issue during the 90-day window, use modifier 79. Routine post-op E/M visits are bundled; an E/M for a new problem gets modifier 24.

05Is modifier 50 correct for bilateral foot tendon repairs done in the same session?

Yes, modifier 50 applies when the identical tendon is repaired bilaterally in the same operative session. Bill one line with modifier 50. If different tendons are repaired on each foot, apply LT and RT to separate line items and add modifier 51 for multiple procedures.

06Does 28208 bundle with bunionectomy or hammertoe correction codes?

NCCI PTP edits bundle several foot procedure combinations. If you are reporting 28208 alongside bunionectomy or hammertoe codes on the same date, check the NCCI PTP lookup tool for the specific pair. When the procedures are distinct and separately documented, modifier 59 or the appropriate X modifier can bypass a modifier-indicator-1 edit — but you must have documentation showing a separate anatomical site or distinct procedure.

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 tendon name, anatomical location, repair type (primary vs. secondary), intraoperative findings including gap size and tissue condition, and the surgical approach from dictation. It flags when laterality is not stated and prompts the surgeon before the note closes. This prevents the most common denial trigger for 28208: operative notes that identify a foot extensor repair without specifying which tendon was repaired.

See how Mira captures CPT 28208 documentation