Soft tissue repair · Foot & ankle
Surgical creation of a soft-tissue web between adjacent toes (syndactylization) to stabilize a flail or floppy toe — also called a webbing or Kelikian-type procedure.
Verified May 8, 2026 · 8 sources ↓
- Medicare
- $498.01
- Total RVUs
- 14.91
- Global, days
- 90
- Region
- Foot & ankle
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 8 cited references ↓
- Identify which toes are being syndactylized (e.g., second and third toe) and the foot (left, right, or bilateral).
- Document the underlying diagnosis: flail toe, congenital toe deformity, or acquired soft-tissue defect — vague entries like 'toe deformity' invite denial.
- Describe the surgical technique by name (webbing procedure, Kelikian-type advancement, skin graft if used) — do not write 'standard approach.'
- Record functional impairment: instability, pain with ambulation, difficulty fitting footwear — supports medical necessity and distinguishes from cosmetic-only requests.
- Note anesthesia type (local vs. general) and operative setting (ASC vs. HOPD), which affect site-of-service payment.
- If modifier 22 is appended, include a separate operative note addendum quantifying additional time and complexity above the norm.
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 8 cited references ↓
CPT 28280 covers syndactylization of toes, a reconstructive foot procedure in which skin and soft tissue are surgically joined between two adjacent toes to eliminate an abnormal gap and correct a flail or unstable toe. The technique involves incising along the affected interdigital space, repositioning soft tissue, and sometimes incorporating skin grafts to create a stable web. The Kelikian-type variant uses specific soft-tissue advancement techniques to achieve the fusion. Podiatrists perform the large majority of 28280 cases per CMS Physician Utilization Data.
The code carries a 90-day global period. That window covers the day-before visit, the procedure itself, and all routine post-op care through day 90 — including wound checks, dressing changes, and suture removal. Any E/M visit during the global period for a separate, unrelated condition requires modifier 24. A decision-for-surgery E/M on the day of or day before the procedure needs modifier 57.
The primary indication is a flail or unstable toe resulting from congenital deformity, prior surgery, or acquired soft-tissue loss. ICD-10 diagnosis selection must support medical necessity — cosmetic-only indications trigger payer scrutiny and are frequently non-covered under Medicare. Document the specific toe(s) involved, laterality, and the functional impairment driving the 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 | 5.2 |
| Practice expense RVU | 9.17 |
| Malpractice RVU | 0.54 |
| Total RVU | 14.91 |
| Medicare national rate | $498.01 |
| 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 | $498.01 |
HOPD (APC 5113) Hospital outpatient department | $3,342.87 |
ASC (PI A2) Ambulatory surgical center (freestanding) | $1,644.87 |
Common denial reasons
The recurring reasons claims for CPT 28280 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Cosmetic or elective designation: payers deny when documentation fails to establish functional impairment or medical necessity for the syndactylization.
- Missing laterality: claims without LT or RT modifier — or without toe-level specificity in the operative note — are rejected or pended by many payers.
- Global period conflict: billing a routine post-op visit within the 90-day global without modifier 24 (unrelated E/M) or 79 (unrelated procedure) triggers automatic bundling.
- Diagnosis-procedure mismatch: ICD-10 codes that point to cosmetic toe concerns rather than structural or functional pathology fail medical necessity screens.
- Bilateral billing errors: performing syndactylization on both feet without appending modifier 50 (or submitting as two line items with LT/RT) causes payment reduction or denial.
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 8 cited references ↓
01Is CPT 28280 the right code for hammertoe correction that involves fusing the interphalangeal joint?
02Can 28280 and 28285 be billed together on the same operative session?
03What modifier is needed if both feet are treated at the same operative session?
04Does 28280 require preoperative imaging documentation?
05What ICD-10 codes typically support medical necessity for 28280?
06If the patient returns to the OR within the 90-day global for a complication related to the syndactylization, which modifier applies?
07Is 28280 typically performed in an ASC or hospital outpatient setting, and does it matter for payment?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02aapc.comhttps://www.aapc.com/codes/cpt-codes/28280
- 03mdclarity.comhttps://www.mdclarity.com/cpt-code/28280
- 04genhealth.aihttps://genhealth.ai/code/cpt4/28280-syndactylization-toes-eg-webbing-or-kelikian-type-procedure
- 05emedny.orghttps://www.emedny.org/ProviderManuals/Podiatry/PDFS/Podiatry_Procedure_Codes.pdf
- 06fastrvu.comhttps://fastrvu.com/cpt/28280
- 07coa.orghttps://coa.org/docs/2012-Annual-Meeting/EllisStephaniePresentation.pdf
- 08cms.govhttps://www.cms.gov/medicare/regulations-guidance/physician-self-referral/list-cpt-hcpcs-codes
Mira AI Scribe
Mira's AI scribe captures the specific toes involved, foot laterality, surgical technique name (webbing or Kelikian-type), skin graft use if applicable, and the functional diagnosis driving the procedure — all from dictation in real time. That prevents the two most common 28280 denials: missing laterality and a cosmetic-only diagnosis that can't support medical necessity.
See how Mira captures CPT 28280 documentation