Soft tissue repair · Foot & ankle

28262

Capsulotomy of a major joint of the foot with extensive release of multiple contractures, performed as a revision or complex corrective procedure.

Verified May 8, 2026 · 6 sources ↓

Medicare
$1,480.33
Total RVUs
44.32
Global, days
90
Region
Foot & ankle
Drawn from CMSCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

  • Operative note must identify the specific joint(s) released by name, not 'standard approach' or generic language
  • Document prior treatment history — surgical or conservative — establishing medical necessity for revision-level release
  • Describe each structure released (capsule, ligaments, tendons) and the anatomic extent of the release performed
  • Record intraoperative findings that distinguish this from a primary or limited capsulotomy, including deformity type and severity
  • Include pre- and post-operative weight-bearing or fluoroscopic imaging findings that support the diagnosis and planned correction
  • Note laterality explicitly — left, right, or bilateral — in both the preoperative diagnosis and the operative report

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 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 28262 describes an extensive capsular release involving a major joint of the foot, typically performed to correct severe or recurrent deformity — most commonly rigid flatfoot or equinovarus contractures — where prior conservative treatment or surgery has failed. The procedure involves opening the joint capsule and releasing multiple contracted soft-tissue structures to restore alignment and mobility. It is a substantially more involved undertaking than a simple capsulotomy, and operative documentation must reflect the extent of release performed.

The 90-day global period means all routine follow-up visits, wound checks, and cast or splint changes through day 90 are bundled into payment. Any E/M service for a new or unrelated condition in that window requires modifier 24. If a staged or related procedure is performed after the initial surgery within the global period, modifier 78 applies for a return to the OR for a complication; modifier 79 covers an unrelated procedure in the same window.

Bilateral cases — rare but possible — require modifier 50 or laterality modifiers LT/RT on separate claim lines depending on payer rules. Modifier 22 is supportable when operative complexity significantly exceeds typical cases, but the operative note must explicitly describe what made the case extraordinary. Payers vary on whether modifier 22 triggers manual review versus automatic payment; expect pre-payment scrutiny.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU16.78
Practice expense RVU24.34
Malpractice RVU3.2
Total RVU44.32
Medicare national rate$1,480.33
Global period90 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

SettingMedicare rate (national)
Office (PFS non-facility)
Procedure performed in physician's office
$1,480.33
HOPD (APC 5114)
Hospital outpatient department
$7,413.38
ASC (PI J8)
Ambulatory surgical center (freestanding)
$4,682.29

Common denial reasons

The recurring reasons claims for CPT 28262 get rejected.

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

  • Operative note lacks specificity on structures released, triggering downcoding to a less complex capsulotomy code
  • Medical necessity not established — no documentation of failed prior treatment or prior surgical history
  • Modifier 22 claimed without operative note language quantifying the additional work or time beyond typical
  • Bundling conflict when concomitant tendon or osteotomy codes are billed without appropriate modifier to establish separate and distinct service
  • Laterality missing or conflicting between claim and operative report, causing payer rejection

Frequently asked questions

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

01What distinguishes 28262 from a simpler foot capsulotomy code?
28262 is reserved for extensive, multi-structure releases at a major foot joint — typically involving the capsule plus additional contracted soft tissues — and is most appropriate in the revision or complex deformity setting. A limited or single-plane release at a lesser joint codes differently. The operative note must support the extent of release to justify 28262 over a less comprehensive code.
02Can 28262 be billed with osteotomy or tendon transfer codes on the same day?
Yes, when performed as distinct surgical components of a complex reconstruction, co-surgery coding is supportable with appropriate modifiers (59 or XS) to bypass NCCI bundling edits where modifier indicator 1 applies. Check the NCCI PTP lookup for each specific code pair — some combinations carry a modifier indicator of 0 and cannot be unbundled regardless of documentation.
03How does the 90-day global period affect post-op billing for 28262?
All routine follow-up through day 90 is bundled — no separate E/M for cast changes, wound checks, or routine progress visits. Modifier 24 is required for E/M visits addressing an unrelated condition. Modifier 78 covers an unplanned return to the OR for a related complication; modifier 79 covers an unrelated procedure within the global window.
04Is modifier 22 defensible for an unusually complex 28262 case?
Yes, but the operative note has to do the work. Document the specific factors — severe fibrosis from prior surgery, neurovascular anatomy requiring protection, extended operative time — and quantify when possible. Modifier 22 without supporting narrative is a common audit target and payers often require medical records before processing the additional reimbursement.
05What NCCI bundling issues come up most often with 28262?
Tendon lengthening and certain osteotomy codes are frequent co-billed procedures that may trigger PTP edits. Use the CGS or CMS NCCI PTP lookup tool to check modifier indicator status for each pair before submitting. Modifier 59 or XS can bypass edits with indicator 1 when the procedures are genuinely distinct; indicator 0 pairs cannot be unbundled under any circumstances.
06How should bilateral cases be billed?
Use modifier 50 on a single line or report on two separate lines with LT and RT — payer rules vary and some commercial payers reject modifier 50 in favor of separate line billing. Confirm your specific payer's preference before submitting. Medicare generally accepts modifier 50 on a single line for bilateral surgical procedures.

Sources & references

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

  1. 01CMS Physician Fee Schedule 2026
  2. 02
    cms.gov
    https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-procedure-procedure-ptp-edits
  3. 03
    cgsmedicare.com
    https://www.cgsmedicare.com/medicare_dynamic/j15/partb/ptpb/ptp.aspx
  4. 04
    cms.gov
    https://www.cms.gov/files/document/medicare-ncci-policy-manual-2024-chapter-4.pdf
  5. 05
    cms.gov
    https://www.cms.gov/files/document/2026-ncci-medicaid-policy-manual.pdf
  6. 06
    cms.gov
    https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c23.pdf

Mira AI Scribe

Mira's AI scribe captures joint name, structures released, laterality, intraoperative deformity findings, and prior surgical history directly from dictation for 28262. That documentation chain prevents downcoding audits that target operative notes lacking explicit release inventory and revision context.

See how Mira captures CPT 28262 documentation

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