Open tenotomy of an extensor tendon of the foot or toe, reported per tendon divided.

Verified May 8, 2026 · 6 sources ↓

Medicare: $411.83
Total RVUs: 12.33
Global, days: 90
Region: Foot & ankle

Drawn from CMSEmednyAAPCThehaugengroupPrc

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 divided by name (e.g., extensor digitorum longus, extensor hallucis longus) and the toe or ray affected.
Describe the incision location and confirm it is a separate incision if billing alongside 28285 or another foot procedure.
Document the clinical indication — hammertoe, claw toe, extensor contracture — and that conservative treatment was attempted and failed.
Record the surgical approach, instruments used, and wound closure technique; notes stating 'standard approach' are flagged on audit.
For multiple tendons billed on the same date, document each tendon release individually with distinct findings justifying each.

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 50 Bilateral procedure 51 Multiple procedures 58 Staged or related 59 Distinct service 76 Repeat, same physician 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 28234 describes an open surgical release of an extensor tendon in the foot or toe. The surgeon makes a skin incision, identifies the contracted tendon, and divides it to relieve tension — most commonly to correct hammertoe, claw toe, or other extensor contracture deformities that have failed conservative care. The code is reported per tendon, so if two separate extensor tendons are released through separate incisions at the same session, bill 28234 twice with modifier 51 on the second unit.

The 90-day global period covers all routine postoperative management through day 90. Any E/M visit for a new or unrelated problem during that window requires modifier 24. A staged or planned secondary procedure requires modifier 58; an unplanned return to the OR for a related complication gets modifier 78.

Bundling is the top billing trap here. When 28234 is performed on the same toe as a hammertoe correction (28285), it is bundled — 28285 includes the extensor tenotomy as a component. If the tenotomy is performed through a genuinely separate incision on a different toe or a distinct anatomical site, append modifier 59 (or XS) and document the distinct incision explicitly. Local anesthesia administration is never separately billable as an injection code.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	3.45
Practice expense RVU	8.51
Malpractice RVU	0.37
Total RVU	12.33
Medicare national rate	$411.83
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	$411.83
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 28234 get rejected.

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

Bundled into 28285 (hammertoe correction) when performed on the same toe without documentation of a separate, distinct incision.
Insufficient documentation of which specific tendon was divided — payer cannot confirm medical necessity without tendon identification.
Missing evidence of failed conservative treatment (orthotics, physical therapy) prior to surgical intervention.
Modifier 59 appended without operative note supporting a separate incision or distinct procedural service.
Global period conflict — postoperative E/M billed without modifier 24 when the visit falls within the 90-day global window.

Frequently asked questions

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

01Is 28234 bundled into 28285 (hammertoe correction)?

Yes, when performed on the same toe. Per AAOS guidelines, 28285 includes the extensor tenotomy as a component. If the tenotomy is done through a separate incision on a different toe, bill 28234 with modifier 59 or XS and document the distinct incision in the operative note.

02How do you bill 28234 when two extensor tendons are released at the same session?

Report 28234 for the first tendon and 28234-51 for the second. The code is defined per tendon, so each release counts as a separate unit. Document each tendon by name and incision location.

03What modifier is needed for a bilateral extensor tenotomy performed at the same operative session?

Use modifier 50 for a true bilateral procedure (both feet). Use LT and RT if the payer requires separate line items. Confirm payer preference — some Medicare contractors want modifier 50 on a single line; others want two lines.

04Can you separately bill a local anesthesia injection alongside 28234?

No. Local anesthesia administration is bundled into the surgical procedure and is not separately reportable under any injection CPT code. Billing it separately is a misuse of injection codes per NCCI policy.

05What modifiers apply when a complication requires a return to the OR during the 90-day global period?

Use modifier 78 for an unplanned return to the OR for a complication related to the original procedure. Use modifier 79 if the return is for a completely unrelated procedure performed by the same surgeon during the global period.

06Does 28234 apply to both foot and toe extensor tendons?

Yes. The code covers open tenotomy of extensor tendons at the foot level (e.g., extensor digitorum longus mid-foot) and at the toe level. Document which anatomical level was addressed to support medical necessity and distinguish from flexor tenotomy codes 28230 and 28232.

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 tendon name, the toe or ray involved, the incision location, and whether the release was performed through a separate incision from any concurrent procedure. It also flags when 28234 is dictated alongside 28285 on the same toe, prompting the coder to confirm distinct-site documentation before billing both — preventing the most common bundling denial for this code.

See how Mira captures CPT 28234 documentation