Open surgical release of one or more flexor tendons in the foot to correct deformity caused by tendon contracture or shortening.

Verified May 8, 2026 · 6 sources ↓

Medicare: $430.54
Total RVUs: 12.89
Global, days: 90
Region: Foot & ankle

Drawn from CMSGenhealthEmednyAAPCFindacode

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify each specific tendon released by name and location (e.g., flexor digitorum longus at digit 2)
State the underlying deformity and clinical indication (congenital vs. acquired contracture, specific toe affected)
Document failed conservative management or rationale for surgical intervention
Describe the open approach including incision location and confirmation of tendon division
Record intraoperative correction achieved and any concurrent procedures performed on the same foot
If billing bilateral, document separate operative findings for each foot with laterality clearly stated

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 28230 describes an open tenotomy of the flexor tendon(s) of the foot — a procedure in which the surgeon makes a direct incision to divide a tight or contracted flexor tendon, relieving the deformity it causes. The code covers single or multiple tendons addressed through the same operative session and is designated a separate procedure, meaning it is typically not reported when performed as a component of a more comprehensive foot reconstruction.

The procedure is performed for congenital or acquired conditions where flexor tendon shortening drives deformity — most commonly hammertoe variants, claw toe, or pediatric equinus deformity not amenable to closed methods. Podiatry and orthopedic surgery are the top billing specialties. The 90-day global period covers all routine post-op care through day 90; use modifier 24 or 25 for unrelated E/M visits and modifier 78 for any unplanned return to the OR for a related problem within that window.

Site of service matters significantly for this code. The HOPD and ASC facility payments differ substantially — see the Site of Service comparison table. Because the code carries the 'separate procedure' designation, payers will bundle it if billed alongside a more comprehensive foot tendon repair or reconstruction on the same foot at the same session. Modifier 59 or XS is required to unbundle only when the tenotomy is genuinely distinct from any co-billed procedure.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	4.25
Practice expense RVU	8.21
Malpractice RVU	0.43
Total RVU	12.89
Medicare national rate	$430.54
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	$430.54
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI P3) Ambulatory surgical center (freestanding)	$275.92

Common denial reasons

The recurring reasons claims for CPT 28230 get rejected.

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

Bundled into a more comprehensive foot tendon procedure billed the same day without modifier 59 or XS
Missing laterality modifier (LT or RT) causing claim rejection or payer-level edit failure
Lack of documented conservative treatment failure prior to surgical authorization
Operative note states 'tenotomy performed' without specifying which tendon(s) or approach, triggering medical necessity denial
Bilateral procedure billed on two separate claim lines without modifier 50, leading to duplicate claim edit

Frequently asked questions

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

01Does 28230 cover multiple tendons or do I bill a unit for each tendon released?

One unit of 28230 covers single or multiple flexor tendons released in the foot at the same session. Don't stack units per tendon — the code description explicitly includes multiple tendons.

02Can I bill 28230 with a hammertoe repair like 28285 on the same day?

Generally no without a modifier. 28230 is designated a separate procedure and will bundle into 28285 under NCCI edits. If the tenotomy was performed at a distinct site not integral to the hammertoe repair, append modifier 59 or XS and support it with documentation of the separate tendon and location.

03What global period applies to 28230, and how does that affect post-op billing?

28230 carries a 90-day global period. Routine post-op visits, wound checks, and dressing changes within 90 days are bundled into the surgical fee. Use modifier 24 for unrelated E/M services and modifier 78 for an unplanned return to the OR for a related complication during that window.

04How do I bill if the procedure is performed on both feet at the same session?

Append modifier 50 for a bilateral procedure billed on a single claim line. Some payers require separate lines with LT and RT instead — verify payer-specific instructions before submitting. Either way, document distinct operative findings for each foot.

05Is modifier 22 appropriate if the surgeon released an unusually large number of contracted tendons?

Yes, if the work substantially exceeded a typical single or dual tenotomy — for example, releasing five severely scarred tendons with extensive dissection. The operative note must document the specific reasons for increased time and complexity. Attach a cover letter; most payers require it with modifier 22 claims.

06What is the difference between 28230 and 28232?

28230 covers open flexor tenotomy of the foot (all flexor tendons at the foot level). 28232 is specifically for open tenotomy of a toe flexor tendon. When the contracture is at the toe rather than the foot, 28232 is the correct code. Anatomy in the operative note determines which applies.

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 specific flexor tendon(s) released, the digit and foot involved, the clinical deformity corrected, and the open incision approach from the surgeon's dictation. It flags when multiple tendons are addressed so the coder knows a single 28230 unit covers them all, and it notes any co-billed procedures that could trigger a bundling edit — preventing the most common denial this code sees.

See how Mira captures CPT 28230 documentation