Secondary repair of a foot extensor tendon using a free graft, including harvesting the graft, per tendon.

Verified May 8, 2026 · 6 sources ↓

Medicare: $597.88
Total RVUs: 17.9
Global, days: 90
Region: Foot & ankle

Drawn from CMSAcgmeAAPCAacpmGomedicalbilling

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify that the repair is secondary (delayed), not primary — establishes medical necessity for graft use
Identify the tendon by name and anatomic location (e.g., extensor digitorum longus to second toe)
Document graft source, type (autograft vs. allograft), and harvest site if autograft
Describe the mechanism and nature of the original injury and why primary repair was not performed or failed
Record intraoperative findings including tendon defect size, condition of tendon ends, and graft fixation method
Note laterality clearly (left vs. right foot) to support LT/RT modifier use

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 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 28210 covers a delayed (secondary) surgical repair of a ruptured or torn extensor tendon in the foot — the tendons responsible for straightening the toes — using a free graft. Graft harvest is included in the code; do not bill it separately. This is a per-tendon code: if two extensor tendons are repaired with separate grafts in the same session, bill 28210 twice with modifier 51 on the second unit.

The 90-day global period means the surgeon's postoperative visits, wound checks, and routine follow-up through day 90 are bundled. Unrelated E/M services in that window need modifier 24. A same-day E/M that drives the surgical decision needs modifier 25. If the patient returns to the OR for a related complication within the global, use modifier 78; for an unrelated procedure, use modifier 79.

Distinguish 28210 from its neighbors before billing: 28208 covers primary or secondary extensor repair without a graft; 28202 covers secondary flexor repair with a free graft; 28200 covers flexor repair without a graft. Selecting the wrong code — especially confusing extensor and flexor, or graft vs. no-graft — is the most common miscoding pathway for this family.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.36
Practice expense RVU	10.76
Malpractice RVU	0.78
Total RVU	17.9
Medicare national rate	$597.88
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	$597.88
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,832.53

Common denial reasons

The recurring reasons claims for CPT 28210 get rejected.

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

Billing 28210 for a primary repair — payers require documentation of delayed/secondary presentation to justify graft
Failing to distinguish extensor from flexor repair, triggering a code mismatch with the ICD-10 diagnosis code
Billing graft harvest separately when it is already included in the 28210 descriptor
Missing laterality modifier (LT or RT), causing claim suspension or rejection on bilateral tendon repair claims
Insufficient documentation of tendon defect requiring graft — payers audit operative notes that omit defect size or condition of tendon ends

Frequently asked questions

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

01Can I bill 28210 for a primary extensor tendon repair?

No. 28210 is specifically a secondary (delayed) repair with free graft. For a primary extensor repair without a graft, use 28208. Billing 28210 for a primary repair will likely trigger a medical necessity denial.

02Is graft harvest billed separately when using 28210?

No. The descriptor explicitly includes obtaining the graft. Billing a separate graft harvest code alongside 28210 will be bundled and denied.

03If I repair two extensor tendons with separate grafts in the same session, how do I bill?

Bill 28210 twice — once per tendon. Append modifier 51 to the second unit to indicate multiple procedures. Document each tendon separately in the operative note.

04What modifier is needed for a same-day E/M that leads directly to scheduling this surgery?

Modifier 57 applies when the E/M results in the decision to perform a 90-day global surgery. If the E/M is on the same day as the surgery itself and is a significant separately identifiable service, use modifier 25.

05How does 28210 differ from 28202?

28202 covers secondary repair of a flexor tendon with a free graft. 28210 covers the same construct for extensor tendons. Confirm the tendon type in the operative report before selecting between them — ICD-10 diagnosis codes must align with extensor pathology for 28210.

06What modifier applies if the patient returns to the OR within the 90-day global for a complication of this repair?

Use modifier 78 for an unplanned return to the OR for a complication related to the original extensor tendon repair. Use modifier 79 if the return procedure is entirely unrelated to the index surgery.

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, anatomic location, repair timing (secondary/delayed), graft type and harvest site, defect size, and fixation technique directly from the surgeon's dictation. This prevents the most common audit flag on 28210 claims: operative notes that confirm a repair was done but fail to document why a free graft was required or that the repair was secondary rather than primary.

See how Mira captures CPT 28210 documentation