Surgical correction of hallux valgus (bunion) via distal metatarsal osteotomy, with removal of the bony prominence and optional sesamoidectomy, using any fixation method.

Verified May 8, 2026 · 6 sources ↓

Medicare: $883.45
Total RVUs: 26.45
Global, days: 90
Region: Foot & ankle

Drawn from AAPCMdclarityCMSMedicare.govPayerprice

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify osteotomy site explicitly as distal metatarsal — not just 'metatarsal osteotomy' — to distinguish 28296 from 28295 (proximal) or 28297 (Lapidus)
Name the osteotomy technique used (e.g., chevron, Austin, Mitchell) and confirm distal location in the operative note
Document whether sesamoidectomy was performed and the clinical rationale if sesamoid(s) were excised
Record the type and placement of internal fixation hardware if used (screws, pins, staples), including size when applicable
Confirm pre-operative radiographs measuring hallux valgus angle (HVA) and intermetatarsal angle (IMA) are in the chart to support medical necessity
Laterality must be explicit in both the operative report and the claim — left, right, or bilateral

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 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 28296 covers bunion correction at the distal metatarsal — the surgeon cuts and repositions the first metatarsal head to realign the hallux valgus deformity, removes the medial eminence (the bony bump), and may excise one or both sesamoid bones if clinically indicated. Internal fixation (screws, staples, or pins) to hold the osteotomy in the corrected position is included in the code. The phrase 'any method' means the specific osteotomy technique — chevron, Austin, Mitchell, or similar — doesn't change the code.

Distinguish 28296 from its neighbors: 28295 is the proximal metatarsal osteotomy variant; 28297 adds first metatarsal–medial cuneiform joint arthrodesis (Lapidus procedure). If you perform a proximal osteotomy instead of a distal one, 28296 is the wrong code. Payers audit these distinctions closely, so operative notes must specify osteotomy location.

The 90-day global period applies. All routine post-op visits, wound checks, and hardware-related dressing changes through day 90 are bundled. Unrelated problems billed in that window require modifier 24. A staged or planned second procedure in the global period needs modifier 58; an unplanned return to the OR for a related complication uses 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	8.04
Practice expense RVU	17.59
Malpractice RVU	0.82
Total RVU	26.45
Medicare national rate	$883.45
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	$883.45
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 28296 get rejected.

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

Laterality missing or ambiguous on the claim — payers reject 28296 without LT, RT, or 50 modifier
Medical necessity not established — no documented radiographic angles, failed conservative care, or functional limitation prior to surgery
Osteotomy site not specified in the op note, causing payer to question whether distal (28296) or proximal (28295) technique was used
Bundling conflict when additional foot procedures billed same-day lack modifier 59 or XS to establish separate, distinct service
Post-op visit billed by same provider within the 90-day global period without modifier 24 (unrelated) or 79 (unrelated procedure)

Frequently asked questions

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

01What's the difference between 28295, 28296, and 28297?

28295 = proximal metatarsal osteotomy. 28296 = distal metatarsal osteotomy (any method). 28297 = bunion correction combined with first metatarsal–medial cuneiform arthrodesis (Lapidus). Osteotomy location — not technique name — determines whether you use 28295 or 28296.

02Can 28296 be billed bilaterally if both feet are done in the same surgical session?

Yes. Append modifier 50 for bilateral same-session correction, or use LT and RT on separate line items depending on payer preference. Confirm the payer's bilateral payment policy — some apply a 150% rule, others pay 200%.

03Is sesamoidectomy always included in 28296, or can it be billed separately?

Sesamoidectomy is included when performed — that's explicit in the code descriptor. You cannot unbundle it as a separate line item regardless of whether one or both sesamoids are excised.

04What ICD-10 diagnosis codes are typically accepted with 28296?

M20.10 (hallux valgus, unspecified foot), M20.11 (right foot), and M20.12 (left foot) are the primary payer-accepted diagnoses. Laterality on the diagnosis code must match the procedure modifier.

05How does the 90-day global period affect office visits after surgery?

All routine follow-up visits for the bunion correction through day 90 are bundled. To bill a visit in that window for a problem unrelated to the bunion — say, a new ankle sprain — append modifier 24 and document clearly that the visit addressed a distinct condition.

06If the surgeon needs to return the patient to the OR during the global period to address a hardware complication, which modifier applies?

Modifier 78 covers an unplanned return to the OR for a complication related to the original procedure (e.g., screw prominence, wound dehiscence requiring washout). Modifier 79 is for an unrelated procedure by the same surgeon in the same global window — do not invert these.

07Can modifier 22 be used if the correction was technically more demanding than usual?

Yes, but document specifically what made the work substantially greater — severe deformity magnitude, prior failed surgery, complex anatomy, significantly extended operative time. A vague note saying 'difficult case' won't survive audit. Attach operative photos or prior imaging when available.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures osteotomy site (distal vs. proximal), technique name, laterality, fixation hardware details, and whether sesamoidectomy was performed — pulling these directly from the surgeon's dictation. That prevents the most common 28296 audit flag: an operative note that says 'metatarsal osteotomy' without confirming the distal location, which gives payers grounds to question code selection or downcode to a less specific procedure.

See how Mira captures CPT 28296 documentation