Surgical release of one or more midtarsal (midfoot) joints by incising the joint capsule and surrounding soft tissues to correct contracture or restore range of motion.

Verified May 8, 2026 · 5 sources ↓

Medicare: $959.61
Total RVUs: 28.73
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPC

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Identify the specific midtarsal joint(s) released (e.g., talonavicular, calcaneocuboid) — 'midfoot joint' alone is insufficient for audit purposes.
Document failed conservative treatment prior to surgery, including duration and modalities tried.
Operative note must name the surgical approach and describe the capsular and soft-tissue structures incised or released.
Include pre-operative range-of-motion measurements and intraoperative findings confirming contracture.
Specify laterality (left, right, or bilateral) in both the operative note and the diagnosis coding.
If modifier 22 is applied, document the specific factors that increased operative complexity beyond the typical case.

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 25 Significant separate E/M 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

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 28264 covers open capsulotomy of the midfoot — specifically the midtarsal joint complex — performed to address resistant contractures or significant loss of motion that hasn't responded to conservative management. The surgeon incises the joint capsule and releases the restricting soft-tissue structures to restore functional alignment and mobility. Indications commonly include rigid flatfoot deformity, equinovarus contracture, and post-traumatic or post-surgical stiffness involving the talonavicular, calcaneocuboid, or adjacent midtarsal articulations.

This is a 90-day global procedure. All routine post-op visits, wound checks, and suture removals through day 90 are bundled into the surgical payment. Billing an E&M during the global period requires modifier 24 (unrelated problem) or modifier 25 (separate, significant E&M on the day of surgery). Local anesthesia administration is not separately reportable — NCCI policy folds it into the surgical package. If fluoroscopy is used intraoperatively, it is integral and cannot be billed separately.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.38
Practice expense RVU	16.62
Malpractice RVU	1.73
Total RVU	28.73
Medicare national rate	$959.61
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	$959.61
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 28264 get rejected.

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

Missing or vague laterality in the claim — payers reject claims that don't match LT/RT modifier to procedure line.
Separate billing of local anesthesia administration, which is bundled into the surgical package under NCCI policy.
E&M billed same-day without modifier 25, triggering automatic bundling into the global surgical payment.
Insufficient documentation of medical necessity — operative notes that reference only 'midfoot pain' without objective contracture findings or failed conservative care.
Fluoroscopy billed separately when used intraoperatively — it is integral to the procedure and not independently reimbursable.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Can 28264 be billed bilaterally on the same date of service?

Yes. Bill 28264-LT and 28264-RT on separate lines, or use modifier 50 per your payer's preference. Confirm bilateral policy with each payer before submission — some require two line items, others accept modifier 50 on a single line.

02What is the global period for 28264?

90 days. The pre-operative day, the surgery, and all routine post-op care through day 90 are bundled. Unrelated services in that window need modifier 24 on E&M codes or modifier 79 on unrelated surgical procedures.

03Can I bill an E&M on the same day as 28264?

Only if it is a significant and separately identifiable service unrelated to the decision to perform the release. Append modifier 25 to the E&M. The E&M and the procedure do not require different diagnoses, but the documentation must clearly support distinct work.

04Is fluoroscopy separately billable when used during this procedure?

No. Per NCCI policy, fluoroscopy used during a musculoskeletal surgical procedure is integral to that procedure. Do not bill a separate fluoroscopy code.

05When does modifier 22 apply to 28264?

When the procedure required substantially more work than typical — for example, dense post-traumatic scarring, prior surgical hardware in the field, or severe multiplanar deformity significantly extending operative time. The operative note must document the specific complicating factors; payers will not approve modifier 22 based on a generic complexity statement.

06How does 28264 interact with other foot procedures billed on the same date?

Use modifier 51 when billing 28264 alongside other surgical procedures on the same date. Review NCCI PTP edits for your specific code combination — contiguous anatomical sites may restrict use of unbundling modifiers.

07What ICD-10 diagnoses typically support medical necessity for 28264?

Codes for acquired foot deformities, joint contracture of the foot, and post-traumatic or post-surgical stiffness of midfoot joints are the most common supporting diagnoses. The chosen ICD-10 code must reflect the specific clinical finding documented in the operative note — a generic foot pain code will likely trigger a medical necessity denial.

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 joint released (talonavicular, calcaneocuboid, or other midtarsal articulation), the laterality, the structures incised, and the degree of contracture noted intraoperatively. It also flags whether conservative treatment history is documented in the note — the most common missing element that prompts medical necessity denials on 28264 claims.

See how Mira captures CPT 28264 documentation