Soft tissue repair · Foot & ankle

28297

Hallux valgus correction with bunionectomy (including sesamoidectomy when performed) and first metatarsocuneiform joint arthrodesis, any method.

Verified May 8, 2026 · 7 sources ↓

Medicare
$1,030.75
Total RVUs
30.86
Global, days
90
Region
Foot & ankle
Drawn from CMSNimblercmPodiatrymTldsystemsThehaugengroup

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

  • Explicit documentation of medial eminence resection of the first metatarsal head — its absence makes 28297 incorrect per AMA CPT guidance
  • Operative note must name the arthrodesis site as the first metatarsocuneiform joint and describe the fixation method used
  • Document whether sesamoidectomy was performed; if so, include rationale and technique
  • If Lapiplasty technique was used, document the metatarsal rotation correction and confirm the capsulotomy was integral to the arthrodesis, not a standalone service
  • Laterality must be specified (left, right, or bilateral) in both the operative note and on the claim
  • If billing a concurrent Akin osteotomy (28310), document its distinct clinical indication and separate anatomic site in the operative report

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 59 Distinct service LT Left side RT Right side 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 28297 covers surgical correction of hallux valgus that combines a bunionectomy — which requires resection of the medial eminence of the first metatarsal head — with arthrodesis of the first metatarsocuneiform joint. Sesamoidectomy is included when performed. The code applies regardless of the specific arthrodesis technique used. Lapiplasty falls under this code when all required components are performed, including the medial eminence resection.

The medial eminence removal is not optional — it's a defining element of the 'bunionectomy' descriptor. Per CPT Assistant (December 2016), any code billed as a bunionectomy must include removal of prominent or hypertrophied bone from the medial aspect of the first metatarsal head. If the metatarsocuneiform arthrodesis is performed without that resection, 28297 does not apply. In that scenario, 28740 (arthrodesis, midtarsal or tarsometatarsal, single joint) is the appropriate code.

The 90-day global period encompasses the surgery, the pre-operative day-before visit, and all routine post-op care through day 90. Separate billing for capsulotomy (28270) during the same session is not supported when it's a necessary step within the arthrodesis technique — it doesn't represent a distinct service. An Akin osteotomy (28310) may be separately reportable with modifier 59 when clearly documented as a distinct procedure, but payers including CIGNA, Tufts, and UHC routinely bundle it; expect to appeal with NCCI modifier indicator documentation.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU9.06
Practice expense RVU20.68
Malpractice RVU1.12
Total RVU30.86
Medicare national rate$1,030.75
Global period90 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

SettingMedicare rate (national)
Office (PFS non-facility)
Procedure performed in physician's office
$1,030.75
HOPD (APC 5115)
Hospital outpatient department
$13,116.76
ASC (PI J8)
Ambulatory surgical center (freestanding)
$10,002.69

Common denial reasons

The recurring reasons claims for CPT 28297 get rejected.

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

  • Bundling of CPT 28310 (Akin osteotomy) as Column 2 to 28297 without modifier 59 and supporting documentation of a distinct procedure
  • Incorrect code selection — billing 28297 when medial eminence resection was not performed; 28740 is the correct code in that scenario
  • Separate billing of capsulotomy (28270) when it was a required step within the arthrodesis technique, not a distinct service
  • Missing or ambiguous laterality modifier causing claim-level edits or duplicate-service denials on bilateral cases
  • Global period violations — billing routine post-op visits through day 90 without modifier 24 when the visit is unrelated to the bunion surgery

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What distinguishes 28297 from 28740?
28297 requires both a bunionectomy (with medial eminence resection) and first metatarsocuneiform arthrodesis. If the arthrodesis is performed without the medial eminence resection, 28740 is the correct code. The word 'bunionectomy' in the descriptor is not interchangeable with hallux valgus correction in general — it has a specific anatomical requirement under CPT guidance.
02Should modifier RT or T5 be used to indicate the right foot?
Use modifier RT. The T modifiers (T5 for right great toe) apply to procedures on the phalanges themselves. Since 28297 involves the metatarsocuneiform joint and metatarsal head, RT and LT are the correct laterality modifiers. Some payers accept T5, but RT is the technically correct choice per CPT guidance.
03Can I separately bill the capsulotomy (28270) when Lapiplasty is performed?
No. The capsulotomy performed as part of the metatarsal rotation step in Lapiplasty is integral to the arthrodesis and does not represent a separate and distinct service. AMA CPT Editorial Panel guidance and CMS consensus support bundling 28270 into 28297 in this context.
04Is an Akin osteotomy (28310) separately billable with 28297?
It can be — the NCCI modifier indicator for the 28297/28310 pair is '1 – Allowed,' meaning exceptions apply. Bill 28310 with modifier 59 (or XS for a separate structure) and document the distinct clinical indication and anatomic site in the operative note. Be prepared to appeal; CIGNA, Tufts, and UHC routinely bundle it on initial submission.
05What does the 90-day global period cover for 28297?
All routine post-operative care from the day before surgery through day 90, including office visits, wound checks, dressing changes, and suture removal related to the bunion correction. Unrelated E/M visits within that window require modifier 24. A new, unrelated surgical procedure in the global period requires modifier 79.
06When is modifier 22 appropriate for 28297?
Modifier 22 applies when the procedure required substantially more work than typical — for example, severe deformity, significant scar tissue from prior surgery, or complex multi-plane correction that materially extended operative time. Document the specific complicating factors and increased time in the operative note; payers require compelling written justification before adjusting payment upward.
07Can 28297 be billed bilaterally in the same session?
Yes. Use modifier 50 for bilateral billing on a single line, or bill two lines with LT and RT respectively, depending on payer preference. Medicare generally accepts modifier 50; many commercial payers require separate line items. Verify payer-specific billing instructions before submitting.

Sources & references

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

  1. 01CMS Physician Fee Schedule 2026
  2. 02
    nimblercm.com
    https://nimblercm.com/coding-principles-for-cpt-code-28297-decoding-bunionectomy-procedures/
  3. 03
    podiatrym.com
    https://podiatrym.com/pdf/2021/9/Lehrman921web.pdf
  4. 04
    tldsystems.com
    https://tldsystems.com/index.php/coding-pearls-akin-osteotomy-denials
  5. 05
    thehaugengroup.com
    https://www.thehaugengroup.com/webinar-qa-cpt-bunionectomy-coding/
  6. 06
    medicare.gov
    https://www.medicare.gov/procedure-price-lookup/cost/28297
  7. 07
    cms.gov
    https://www.cms.gov/medicare/regulations-guidance/physician-self-referral/list-cpt-hcpcs-codes

Mira AI Scribe

Mira's AI scribe captures the critical elements for 28297 from dictation: confirmation of medial eminence resection, the arthrodesis site (first metatarsocuneiform joint), fixation method, sesamoidectomy status, and laterality. It flags operative notes that describe arthrodesis without explicit mention of the medial eminence removal — the most common documentation gap that leads to a downcode to 28740 or outright denial.

See how Mira captures CPT 28297 documentation

Related CPT codes

21282 $369.41
Surgical tightening and reattachment of the lateral canthal tendon to restore the outer corner of the eyelid to its correct anatomical position.
28575 $422.52
Closed treatment of a talotarsal joint dislocation performed under anesthesia — meaning the dislocated joint between the talus and an adjacent tarsal bone is manually reduced without surgical opening, but anesthesia is required to achieve it.
27646 $1,389.81
Radical resection of a tumor from the fibula, including removal of wide margins of surrounding normal bone and soft tissue.
26432 $542.76
Closed repair of a finger extensor tendon at its distal insertion — the mallet finger procedure — using splinting with or without percutaneous pin fixation.
Ready?

Ready to transform your orthopedic practice?

See how orthopedic practices are running documentation, billing, and operations on a single voice-first platform.

Get started for free