Open surgical release of a single flexor tendon in the toe, performed to correct deformity or relieve contracture.

Verified May 8, 2026 · 6 sources ↓

Medicare: $374.09
Work RVU: 3.42
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify the specific toe and tendon released (e.g., flexor digitorum longus vs. flexor digitorum brevis, digit number)
Document the clinical indication — deformity type (hammer toe, mallet toe, claw toe) and failure of conservative treatment
Operative note must state 'open' approach; percutaneous release is coded differently
If billed with 28285, document that each code applies to a distinct toe or provide clear medical rationale for same-toe billing
Record pre- and post-release range of motion or deformity correction to support medical necessity

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 28232 covers an open tenotomy of a single flexor tendon of the toe — cutting the tendon under direct visualization to release a contracted digit. It is used most commonly for flexible hammer toe, mallet toe, or claw toe deformities where conservative management has failed and the flexor contracture is the primary driver of the deformity.

The code is designated a 'separate procedure,' which has real billing consequences. NCCI does not bundle 28232 into hammertoe correction code 28285 — but 28285 does bundle the extensor tenotomy (28234). When a surgeon performs a flexor tenotomy on one toe and a hammertoe correction on a different toe in the same session, bill both codes with appropriate digit modifiers (T-codes). If the payer doesn't recognize digit modifiers, append modifier 59 to 28232 to establish a distinct procedural service. When both are performed on the same toe, payer policies diverge — some cover 28232 separately, others bundle it; verify before billing.

The 90-day global period applies. All routine post-op care, wound checks, and dressing changes through day 90 are included. Any unrelated procedure performed during the global window requires modifier 79; a related return to the OR requires modifier 78.

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 (3.42) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (11.2) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	3.42
Practice expense RVU	7.44
Malpractice RVU	0.34
Total RVU	11.2
Medicare national rate	$374.09
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	$374.09
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI P3) Ambulatory surgical center (freestanding)	$250.08

Common denial reasons

The recurring reasons claims for CPT 28232 get rejected.

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

Bundling into 28285 when both codes are billed for the same toe without adequate distinction documented
Missing digit modifier causing claim adjudication to apply NCCI edits incorrectly across toes
Insufficient medical necessity documentation — no record of failed conservative care before open tenotomy
Billing 28232 for a percutaneous release rather than an open procedure

Frequently asked questions

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

01Is 28232 always bundled into hammertoe correction code 28285?

No. NCCI bundles the extensor tenotomy (28234) into 28285, but not the flexor tenotomy (28232). You can bill both when they are performed on separate toes with distinct digit modifiers. Same-toe billing is payer-dependent — verify before submitting.

02Which digit modifiers apply to 28232, and when do you need modifier 59 instead?

Use T-codes (T0–T9) to identify the specific toe. If the payer does not recognize digit modifiers, append modifier 59 to 28232 to signal a distinct procedural service from any co-billed hammertoe correction.

03What global period applies, and what does it cover?

28232 carries a 90-day global period. That includes the day-before visit, the operative session, and all routine post-op care through day 90. Unrelated procedures in the global window need modifier 79; a related return to the OR needs modifier 78.

04Can 28232 be billed bilaterally?

Yes. If flexor tenotomy is performed on toes of both feet in the same session, append modifier 50 for physician billing. In an ASC, bill two lines with modifiers LT and RT per CMS ASC reporting requirements.

05Does the 'separate procedure' designation affect billing with other foot codes?

Yes. 'Separate procedure' means 28232 is typically bundled when it is performed as an integral part of a larger service on the same anatomic site. Bill it separately only when it is the primary procedure or clearly performed on a distinct toe from any co-billed code.

06When is modifier 22 appropriate for 28232?

Use modifier 22 if the release required substantially more work than typical — for example, significant scarring from prior surgery or a severely rigid contracture requiring extensive dissection. Support it with a detailed operative note explaining the added complexity.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the tendon name, the specific digit, and the surgical approach (open) directly from the operative dictation. It flags when the same-session note also includes 28285 and prompts the coder to confirm whether the tenotomy and hammertoe correction were performed on separate toes — the key factor that determines whether modifier 59 or a digit modifier is needed to prevent an NCCI bundling denial.

See how Mira captures CPT 28232 documentation