Hallux rigidus correction with cheilectomy, debridement, and capsular release of the first metatarsophalangeal joint, performed with placement of an implant.

Verified May 8, 2026 · 6 sources ↓

Medicare: $670.36
Work RVU: 7.81
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCEmednyGuidelinesPodiatrym

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm diagnosis of hallux rigidus with clinical and radiographic findings documenting first MTP joint degenerative arthritis and restricted dorsiflexion
Operative note must explicitly name all four components performed: cheilectomy, debridement, capsular release, and implant placement
Specify laterality (left vs. right first MTP joint) in both the diagnosis and operative note
Document implant manufacturer, model, and lot number to support any separate HCPCS Level II device code
Record conservative treatment failure (orthotics, corticosteroid injections, physical therapy, NSAIDs) prior to surgical authorization
Note the extent of osteophyte resection and degree of capsular release to justify complexity if modifier 22 is appended

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 62 Co-surgeons 73 Discontinued pre-anesthesia 74 Discontinued post-anesthesia 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

28291 covers surgical correction of hallux rigidus — end-stage degenerative arthritis of the first MTP joint — when the surgeon performs cheilectomy (resection of dorsal osteophytes), debridement of damaged tissue, capsular release, and places an implant in the joint space. The implant distinguishes this code from its sibling, 28289, which covers the identical soft-tissue work without an implant. Use 28291 only when all four components — cheilectomy, debridement, capsular release, and implant — are performed.

The 90-day global period covers the day-before visit, the surgery, and all routine postoperative care through day 90. Separate same-day billing for 28288, 28306, 28307, 28310, or 28315 on the ipsilateral first toe or metatarsal is prohibited under NCCI policy regardless of modifier. Payers may also require a separate HCPCS Level II code (L8642) for the implant device itself — Medicare has denied 28291 claims where L8642 was omitted, so verify MAC-specific policy before submitting.

Most volume flows through podiatry, with foot-and-ankle orthopedics as a secondary specialty. The procedure is performed in hospital outpatient or ASC settings; see the Site of Service comparison for the payment differential between those two settings.

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 (7.81) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (20.07) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.81
Practice expense RVU	11.54
Malpractice RVU	0.72
Total RVU	20.07
Medicare national rate	$670.36
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	$670.36
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,970.03

Common denial reasons

The recurring reasons claims for CPT 28291 get rejected.

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

Missing HCPCS L8642 for the implant device — some MACs require it alongside 28291 and will deny the CPT alone
Billing 28288 or 28306–28310 or 28315 on the same ipsilateral foot, which are bundled into 28291 under NCCI and will trigger an edit
Lack of documented conservative treatment failure, causing medical necessity denial under payer policies (Humana, Cigna)
Laterality modifier absent or mismatched between the claim and the operative report
Using 28291 when the operative note describes cheilectomy only without implant — that maps to 28289, not 28291

Frequently asked questions

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

01What is the difference between 28289 and 28291?

28289 covers cheilectomy, debridement, and capsular release of the first MTP joint without an implant. 28291 requires all three of those components plus implant placement. If the implant is not placed, bill 28289.

02Do I need a separate HCPCS code for the implant?

Some MACs, including certain Medicare contractors, require HCPCS L8642 for the silicone great toe implant in addition to CPT 28291. Verify with your specific MAC before submitting; omitting L8642 where required is a documented denial reason.

03Can I bill 28288 or 28306 on the same claim as 28291 for the ipsilateral foot?

No. NCCI policy explicitly prohibits separately reporting 28288, 28306, 28307, 28310, and 28315 with 28291-28299 for procedures on the ipsilateral first toe or metatarsal. No modifier overrides this edit.

04Which laterality modifiers apply to 28291?

Use LT for the left foot or RT for the right foot. Modifier 50 applies only if the procedure is performed bilaterally in the same session, which is uncommon for hallux rigidus correction.

05What global period applies, and what does it cover?

28291 carries a 90-day global period. It includes the day-before visit, the surgery itself, and all routine postoperative visits through day 90. Unrelated procedures within the global window require modifier 79; related return-to-OR procedures require modifier 78.

06What ICD-10 diagnosis code is typically paired with 28291?

M20.21 (hallux rigidus, right foot) or M20.22 (hallux rigidus, left foot) are the primary diagnosis codes. Confirm laterality matches the operative report and the LT/RT modifier on the claim.

07Is prior authorization required for 28291?

Most commercial payers and Medicare Advantage plans require prior authorization. Humana and Cigna both publish specific medical policies covering MTP joint implant procedures; documentation of conservative treatment failure is a standard prerequisite.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the four operative components — cheilectomy extent, debridement description, capsular release approach, and implant details (manufacturer, model, laterality) — directly from surgeon dictation. That prevents the most common denial trigger: an operative note that documents the implant placement but omits one of the required soft-tissue steps, causing the claim to fail medical necessity review or be downcoded to 28289.

See how Mira captures CPT 28291 documentation