Surgical correction of hammertoe deformity, which may involve interphalangeal joint fusion, partial or total phalangectomy, arthroplasty, or other procedures that restore normal toe alignment.

Verified May 8, 2026 · 8 sources ↓

Medicare: $548.44
Total RVUs: 16.42
Global, days: 90
Region: Foot & ankle

Drawn from CodingmasteryTldsystemsKzanowAAPCAthelas

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Specify which toe(s) were corrected and the exact joint level addressed (PIP, DIP, or MTP).
Name every component procedure performed — tenotomy, capsulotomy, phalangectomy, fusion, fixation — even if all are bundled into 28285.
Document at least 3 months of failed conservative treatment (orthotics, taping, shoe modification) to establish medical necessity for Medicare and most commercial payers.
Record operative time from incision to closure; payers require this for multi-toe claims, anesthesia billing, and audit defense.
Link each billed line to the correct ICD-10 code (e.g., M20.41 hammertoe right foot, M20.42 hammertoe left foot, Q66.89 congenital foot deformity) and confirm it matches the operative toe.
State the surgical approach and type of fixation (K-wire, implant, suture) by name; generic references to 'standard technique' draw audit scrutiny.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 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 8 cited references ↓

CPT 28285 covers surgical correction of a hammertoe or claw toe deformity on digits two through five. The code is intentionally broad — interphalangeal fusion and phalangectomy are examples, not requirements. Soft tissue releases, extensor tenotomy, flexor tendon transfer, K-wire or internal fixation placement, exostectomy, capsulotomy, and interphalangeal implant insertion are all bundled into 28285 when performed on the same toe. Coding each component separately is unbundling.

The MUE limit is 4 units per session, meaning you can bill 28285 up to four times on a single date when four distinct toes are corrected. Use T-modifiers (T0–T9) to identify each toe; for Medicare, T-modifiers replace modifier 51 for multiple-toe claims. Bilateral procedures on the same toe are not reported with modifier 50 — T-modifiers carry that anatomical distinction. Fluoroscopy used during the hammertoe repair is bundled under NCCI edits; only bill 76000 separately if fluoroscopy was used for a distinct, unrelated purpose documented in the operative report.

The 90-day global period covers all routine post-op visits, hardware checks, and wound care through day 90. An unplanned return to the OR for a related complication in that window requires modifier 78. Corn and callus excision (e.g., 11055) on the same toe at the same session is routinely denied — payers treat it as caused by the hammertoe and therefore included. Separate billing for 28272 (IP joint capsulotomy) or 28270 (MTP capsulotomy) on the same digit is also bundled into 28285.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.48
Practice expense RVU	10.32
Malpractice RVU	0.62
Total RVU	16.42
Medicare national rate	$548.44
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	$548.44
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 28285 get rejected.

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

Missing or insufficient conservative treatment failure documentation — Medicare requires proof of non-surgical management before approving hammertoe repair.
Unbundling: separately billing 28272, 28270, tenotomy, or exostectomy codes for work performed on the same digit at the same session.
MUE violation — billing more than 4 units of 28285 on a single date of service.
Missing or incorrect T-modifier on multi-toe claims, causing lines to deny as duplicates.
Corn/callus excision (11055 or similar) billed same-day on the same toe; payers routinely deny this as caused by and included in the hammertoe correction.
Prior authorization not obtained when required by the payer for elective foot surgery.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01Can 28285 be used for claw toe correction, or is a different code required?

28285 is correct for claw toe correction. CPT doesn't specify which interphalangeal joint — the 'e.g.' language means the listed procedures are examples. Claw toe diagnosis codes (e.g., M20.5X) support medical necessity for 28285, and AMA guidance confirms this usage.

02How do you bill 28285 when multiple toes are corrected on the same date?

Bill a separate line for each toe with the corresponding T-modifier (T0–T9) identifying the exact digit. For Medicare, drop modifier 51 — T-modifiers are sufficient. The MUE cap is 4 units per session. Make sure each line carries the matching ICD-10 code for that toe.

03Is a K-wire or implant billed separately when placed during hammertoe correction?

No. K-wire insertion and interphalangeal implant placement are bundled into 28285 when performed on the same toe as part of the hammertoe correction. Billing them separately is unbundling and will deny.

04Can you separately bill a corn or callus removal on the same toe the same day?

Virtually never, at least not on the same toe. Payers treat the corn or callus as caused by the hammertoe and therefore included in 28285. Exceptions exist for diabetic or PVD patients where a separate medical condition drives the callus, but even then prior authorization and strong documentation are required.

05Does 28285 cover purely soft-tissue hammertoe repairs with no bone work?

This is debated. Some coding authorities recommend CPT 28313 for soft-tissue-only corrections (extensor tenotomy, capsulotomy, flexor tenotomy, K-wire) because 28285 examples all reference bony procedures. 28313 also carries higher RVUs. Review your operative report carefully and confirm with your surgeon before defaulting to 28285 on a purely soft-tissue case.

06What modifier applies if the surgeon returns to the OR during the 90-day global to address a related complication?

Modifier 78 covers an unplanned return to the OR for a complication related to the original hammertoe repair within the 90-day global period. Modifier 79 is for an unrelated procedure in the global window — don't invert these.

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 toe and joint level corrected, every component procedure performed (tenotomy, capsulotomy, phalangectomy, fusion, fixation type), the duration from incision to closure, and the documented history of failed conservative treatment. That prevents the two most common 28285 denials: missing medical necessity documentation and unbundling flags triggered when operative note components aren't clearly attributed to a single hammertoe correction.

See how Mira captures CPT 28285 documentation