Hallux valgus correction (bunionectomy) with resection of the proximal phalanx base and sesamoidectomy when performed, by any method.

Verified May 8, 2026 · 6 sources ↓

Medicare: $703.09
Total RVUs: 21.05
Global, days: 90
Region: Foot & ankle

Drawn from CMSTldsystemsAetnaMdclarityPayerprice

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm medial aspect of the first metatarsal head was resected — post-2024 description requires actual bunionectomy, not realignment alone.
Specify the surgical technique by name (Keller, McBride, Mayo, or other method) in the operative note.
Document whether sesamoidectomy was performed; the code permits it but does not require it.
Document whether proximal phalanx base resection was performed; same conditional language applies.
Record preoperative clinical findings: hallux valgus angle, intermetatarsal angle, and prior conservative treatment failure.
If modifier 22 is appended, the operative note must describe the specific factors that increased surgical complexity and time beyond typical.

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 50 Bilateral procedure 52 Reduced services 58 Staged or related 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 6 cited references ↓

28292 covers surgical correction of hallux valgus — a bunionectomy — that includes resection of the proximal phalanx base, with sesamoidectomy performed when indicated. As of January 1, 2024, the code description was revised to require that the medial aspect of the first metatarsal head actually be resected (bunionectomy); procedures that realign without bony resection no longer satisfy this code. Classic procedures billed under 28292 include the Keller, McBride, and Mayo-type techniques.

This code sits in the middle of the hallux valgus correction family. Procedures involving a proximal metatarsal osteotomy step up to 28295; distal metatarsal osteotomy goes to 28296; first metatarsal-cuneiform arthrodesis goes to 28297; proximal phalanx osteotomy alone goes to 28298. Using 28292 when the operative note describes a proximal or distal metatarsal osteotomy is one of the most common upcoding audit flags in foot surgery.

The 90-day global period covers all routine postoperative management through day 90. Unrelated E/M visits in that window need modifier 24; unrelated procedures need modifier 79; a planned staged procedure needs modifier 58; an unplanned return to the OR for a related complication needs modifier 78.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	7.25
Practice expense RVU	13.02
Malpractice RVU	0.78
Total RVU	21.05
Medicare national rate	$703.09
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	$703.09
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 28292 get rejected.

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

Wrong code selection when a metatarsal osteotomy was also performed — that steps up to 28295, 28296, or 28299 depending on osteotomy location.
Missing LT or RT modifier — many payers require laterality on all foot codes; absence triggers an edit.
Post-2024 operative notes that describe soft-tissue realignment without documented bony resection of the first metatarsal head no longer support 28292.
Bundling conflict when 28090 (ganglion cyst excision, foot) is billed same-day without a modifier establishing a distinct service.
Routine postoperative E/M visits billed without modifier 24 during the 90-day global period are denied as included services.

Frequently asked questions

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

01Does 28292 require sesamoidectomy to be performed?

No. Sesamoidectomy is conditional — 'when performed.' The code is billable whether or not sesamoidectomy is done; just document either way.

02What changed about 28292 on January 1, 2024?

The description was revised so that 'bunionectomy' is now a required component, not just parenthetical. The medial aspect of the first metatarsal head must be resected. Soft-tissue realignment procedures without bony resection no longer satisfy the code.

03Can 28292 and 28298 be billed together on the same foot?

Generally no without strong NCCI modifier justification. 28292 covers proximal phalanx base resection; 28298 covers proximal phalanx osteotomy. Billing both for the same toe on the same date will trigger a bundling edit — verify with your specific payer before appending modifier 59.

04Which modifier do I use for bilateral same-day bunionectomy?

Modifier 50 for bilateral on one line, or bill LT and RT on separate lines — payer-specific. Medicare generally accepts modifier 50 on a single line at 150% of the fee schedule. Confirm your payer's preference before submitting.

05Is an E/M visit on the same day as 28292 billable?

Only if the decision to perform surgery was made at that visit and it was a separately identifiable evaluation. Append modifier 57 for the E/M when it represents the decision for major surgery. Modifier 25 is for minor procedures (0 or 10-day globals), not applicable here.

06How does 28292 differ from 28296?

28292 involves resection of the proximal phalanx base. 28296 involves a distal metatarsal osteotomy (e.g., Chevron/Austin). They are distinct procedures with different RVU weights — select based on what was actually performed at the osteotomy site.

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 technique name (Keller, McBride, Mayo, or other), explicit documentation of medial first metatarsal head resection, whether sesamoidectomy and proximal phalanx base resection were performed, and laterality. That prevents the two most common denials: missing laterality modifier and post-2024 audit flags for operative notes that don't confirm actual bony bunionectomy.

See how Mira captures CPT 28292 documentation