Surgical correction of a hammertoe deformity at the proximal interphalangeal joint, which may involve soft-tissue release, partial or complete bone resection, and stabilization of the affected toe.

Verified May 8, 2026 · 6 sources ↓

Medicare: $430.20
Total RVUs: 12.88
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCMdclarityFastrvuAthelas

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify the exact toe(s) operated on by digit number and laterality (e.g., left second toe)
Document the operative technique in detail — type of bony resection, soft-tissue releases performed, and fixation method used
Record conservative treatment failure: minimum duration, modalities attempted (orthotics, padding, taping, physical therapy), and response
Include pre-operative weight-bearing radiographs confirming the deformity and any structural changes
State the approach and confirm whether the procedure addressed the PIP joint vs. DIP joint, to distinguish from mallet toe codes
Document persistent pain and functional impairment with direct linkage to the hammertoe deformity

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 58 Staged or related 59 Distinct service 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

28286 covers hammertoe repair procedures focused on correcting the abnormal flexion deformity at the proximal interphalangeal (PIP) joint of a lesser toe. The surgery typically involves releasing contracted soft tissues, resecting a portion of the proximal phalanx or the base of the middle phalanx, and restoring alignment — with or without internal fixation such as K-wire or an intramedullary implant.

Distinguish 28286 from 28285 before submitting. 28285 is the more commonly billed hammertoe correction code and covers interphalangeal fusion and partial or total phalangectomy. 28286 targets a distinct repair or reconstruction approach on the same anatomical structure — operative notes must make the technique unambiguous, or auditors will question the code selection. If the procedure was purely soft-tissue with no bony work, 28313 is the better fit.

28286 carries a 90-day global period. All routine post-op visits, dressing changes, and hardware checks fall inside that window. Unrelated E/M or procedures during the global need modifier 24 or 79 respectively. Medicare requires documented failure of conservative care — typically three or more months of orthotics, splinting, or padding — before considering the surgery medically necessary. Missing that documentation is the fastest path to a medical necessity denial.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	4.58
Practice expense RVU	7.9
Malpractice RVU	0.4
Total RVU	12.88
Medicare national rate	$430.20
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	$430.20
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 28286 get rejected.

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

Medical necessity denial for missing or insufficient documentation of failed conservative care prior to surgery
Code selection challenged when operative note does not clearly differentiate 28286 technique from 28285 or 28313
Bundling edits triggered when billing 28286 and another lesser-toe procedure on the same digit without modifier 59
Laterality modifier absent (LT or RT) causing claim suspension or auto-denial from payers requiring side designation
Diagnosis code mismatch — submitting without a specific hammertoe ICD-10 (e.g., M20.41) or linking to a non-covered diagnosis

Frequently asked questions

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

01What is the difference between 28285 and 28286 for hammertoe repair?

28285 is the primary hammertoe correction code, covering interphalangeal fusion and partial or total phalangectomy. 28286 represents a distinct repair or reconstruction approach. The operative note must spell out the specific technique; using the wrong code based on an ambiguous note is an audit risk.

02Can I bill 28286 for multiple toes on the same foot in the same session?

Yes. Each additional toe is a separately billable unit. Append modifier 51 to the lower-valued code and use modifier 59 to distinguish procedures on different digits. Confirm the MUE limit for 28286 before submitting multiple units on a single claim line.

03Does 28286 require prior authorization?

Authorization requirements vary by payer. Medicare does not require prior auth but does require documented conservative treatment failure. Many commercial plans and Medicaid managed care organizations require pre-authorization — verify before scheduling.

04What ICD-10 codes support 28286 for Medicare coverage?

M20.41 (hammertoe of lesser toe, right foot), M20.42 (left foot), and M20.49 (unspecified) are the primary diagnosis codes. Congenital deformity codes such as Q66.89 may apply in select cases. Avoid vague or unspecified toe deformity codes — MACs flag them for medical necessity review.

05How does the 90-day global period affect billing post-operatively?

Routine follow-up, pin removal, dressing changes, and hardware checks are bundled into the global and cannot be billed separately. If a new, unrelated problem is addressed during a post-op visit, append modifier 24 to the E/M or modifier 79 to a separately performed unrelated procedure.

06When should modifier 22 be used with 28286?

Use modifier 22 when the procedure required substantially greater work than typical — for example, severe fibrosis from prior surgery, revision of a failed repair, or complex deformity requiring additional fixation. Attach a cover letter quantifying the increased time and effort; without it, payers routinely ignore modifier 22 and pay at the standard rate.

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 operative approach, specific digit and laterality, type of bony resection or soft-tissue release performed, fixation hardware used, and the documented conservative treatment history from the pre-op note. That detail prevents the two most common 28286 denials: vague operative notes that give auditors room to downcode to 28285 or 28313, and medical necessity rejections tied to absent conservative-care documentation.

See how Mira captures CPT 28286 documentation