Surgical partial excision of a metatarsal head or associated bony prominence on the foot, performed as an open procedure.

Verified May 8, 2026 · 6 sources ↓

Medicare: $610.57
Work RVU: 5.87
Global, days: 90
Region: Foot & ankle

Drawn from CMSFastrvuAAPCMdclarityAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify which metatarsal (1st–5th) and whether the procedure was a condylectomy, exostectomy, or both
Document the laterality (left, right, or bilateral) explicitly in both the operative note and the impression
Record the clinical indication — e.g., intractable plantar keratosis, metatarsalgia, or deformity — with supporting imaging or conservative-treatment failure note
Describe the surgical approach and confirm that the procedure was open, not arthroscopic or percutaneous
Include intraoperative findings: extent of bony resection, condition of surrounding soft tissue, and any concomitant procedures performed
If modifier 22 is used for increased complexity, include a narrative quantifying the additional work and time relative to 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 52 Reduced services 58 Staged or related 59 Distinct service 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 28288 covers open partial removal of a metatarsal head — including condylectomy of the metatarsal head itself or exostectomy of a bony spur or prominence associated with it. It is used most often for painful metatarsalgia, hallux rigidus-adjacent deformity, intractable plantar keratosis, or bony prominence causing footwear conflict. The procedure is distinct from full metatarsal head resection and from cyst or soft-tissue tumor excision (28104).

The 90-day global period means all routine follow-up — wound checks, dressing changes, suture removal, and standard post-op visits — is included in the surgical fee through day 90. Unrelated E/M services in that window require modifier 24; a separately identifiable E/M on the day of surgery requires modifier 25. If additional foot procedures are performed at the same session, list 28288 first only if it carries the highest RVU; apply modifier 51 to lower-ranked secondary procedures.

Side-specific modifiers LT and RT are expected on virtually every claim — payers treating this as a unilateral procedure will deny without them. For true bilateral surgery, modifier 50 applies and most payers reimburse the second side at 50%. Verify NCCI edits before billing 28288 alongside any adjacent soft-tissue or tendon codes on the same foot at the same session.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (5.87) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (18.28) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.87
Practice expense RVU	11.73
Malpractice RVU	0.68
Total RVU	18.28
Medicare national rate	$610.57
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	$610.57
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 28288 get rejected.

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

Missing or ambiguous laterality — LT or RT omitted from the claim line
Bundling conflict when billed same-session with soft-tissue or tendon codes without modifier 59 or XS establishing a distinct service
Medical necessity not supported — no documentation of failed conservative care (orthotics, footwear modification, injections) before surgical intervention
Upcoding allegation when operative note describes only minor exostectomy but 28288 is billed without detail distinguishing it from a lesser procedure
Routine post-op visit billed separately within the 90-day global without modifier 24 indicating an unrelated condition

Frequently asked questions

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

01What is the difference between CPT 28288 and CPT 28104?

28288 is partial removal of a metatarsal head or bony prominence (condylectomy/exostectomy). 28104 covers excision of a bone cyst or benign tumor from the foot. If you removed a discrete cyst or tumor mass — not the metatarsal head itself — 28104 is the correct code. Mixing them triggers audit flags.

02Is modifier 50 correct when both feet are operated on at the same session?

Yes. Bilateral same-session surgery on the same metatarsal position of both feet uses modifier 50. Most Medicare contractors and commercial payers reimburse the second side at 50% of the allowable. Billing two separate line items with LT and RT instead of modifier 50 is also accepted by many payers — verify your specific payer's preference before submitting.

03Can 28288 be billed with other foot procedure codes on the same day?

It can, but check NCCI edits first. When billing with adjacent soft-tissue or tendon procedures on the same foot, modifier 59 or XS is required to establish a distinct service. List the code with the highest RVU first and apply modifier 51 to 28288 if it is the secondary procedure.

04What conservative treatment documentation is needed to support medical necessity?

Most payers require documented failure of at least one conservative measure before approving elective metatarsal head surgery. Document trial of orthotics, accommodative footwear, or corticosteroid injections with dates, duration, and outcome. A note that simply says 'conservative treatment failed' without specifics is frequently returned for more information.

05How does the 90-day global period affect post-op billing for 28288?

All routine follow-up through day 90 is bundled — wound checks, suture removal, and standard post-op visits cannot be billed separately. To bill an E/M during the global for a new or unrelated problem, append modifier 24. If a complication requires a return to the OR for a related procedure, use modifier 78. An unrelated OR procedure in the global period uses modifier 79.

06When is modifier 22 appropriate for 28288?

Modifier 22 is warranted when the procedure required substantially more work than typical — for example, severe deformity, prior surgical scarring requiring extensive dissection, or unusually complex bony anatomy. You must include a written narrative in the claim explaining the additional time and effort. Without that narrative, most payers will strip the modifier and reprocess at the base rate.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the specific metatarsal number, procedure type (condylectomy vs. exostectomy), laterality, surgical approach, and intraoperative findings from dictation — and flags the note when laterality or a named metatarsal is absent. That prevents the single most common denial on 28288 claims: a missing or ambiguous LT/RT modifier traceable back to an incomplete operative note.

See how Mira captures CPT 28288 documentation