Hallux valgus correction (bunionectomy) with sesamoidectomy when performed, using a proximal phalanx osteotomy by any method — the Akin-type procedure.

Verified May 8, 2026 · 7 sources ↓

Medicare: $860.41
Total RVUs: 25.76
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCD148x66490prkvPodiatrymEmedny

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify the osteotomy site explicitly as proximal phalanx — vague terms like 'Akin-type' without anatomic detail invite downcoding queries
Confirm whether sesamoidectomy was performed and document clinical justification if completed
Document the fixation method and implant used (screw, staple, K-wire) including size and position
Record the hallux valgus angle and intermetatarsal angle from preoperative imaging to support medical necessity
Operative note must distinguish a standalone proximal phalanx osteotomy from a double osteotomy — if both phalanx and metatarsal are cut, 28299 applies
Laterality (left vs. right foot) must be explicit in both the operative note and the claim

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 59 Distinct service 73 Discontinued pre-anesthesia 74 Discontinued post-anesthesia 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 28298 covers surgical correction of hallux valgus through a bunionectomy combined with a proximal phalanx osteotomy (Akin procedure). The surgeon resects the medial eminence, cuts and realigns the proximal phalanx of the great toe, and may remove sesamoid bones if clinically indicated. Internal fixation — screw, staple, or wire — is included in the work value and is not separately billable.

This code sits in the 28292–28299 hallux valgus family, where the differentiating factor is the osteotomy site and number. Use 28298 when the osteotomy is isolated to the proximal phalanx. If the surgeon performs both a distal metatarsal osteotomy (e.g., Austin/Chevron) and a proximal phalanx osteotomy (Akin) through a single bunionectomy encounter, the correct code is 28299 (double osteotomy) — not 28296 plus 28298. Billing those two codes together for a single bunionectomy is duplicate billing, not bundling.

The 90-day global period applies. All routine post-op care — wound checks, hardware monitoring visits, suture removal — is included through day 90. Bill unrelated E/M visits in that window with modifier 24. The MUE for 28298 is 1 per foot; bilateral procedures require modifier 50 or separate line items with LT/RT, per payer preference.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	7.56
Practice expense RVU	17.21
Malpractice RVU	0.99
Total RVU	25.76
Medicare national rate	$860.41
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	$860.41
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,682.29

Common denial reasons

The recurring reasons claims for CPT 28298 get rejected.

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

Upcoded or duplicate billing: 28296 and 28298 billed together for an Austin-Akin procedure that should be coded as a single 28299
Missing or inadequate medical necessity documentation — no recorded hallux valgus angle, failed conservative treatment, or functional impairment narrative
Laterality mismatch between operative note and claim line — LT/RT modifier absent or inconsistent with the surgical report
Post-op visit billed without modifier 24 during the 90-day global period, triggering automatic bundling denial
MUE exceeded — 28298 has a MUE of 1 per foot; billing two units on the same foot without bilateral modifier causes rejection

Frequently asked questions

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

01Can I bill 28296 and 28298 together for an Austin-Akin bunionectomy?

No. An Austin-Akin procedure involves two osteotomies on a single bunionectomy — that's 28299 (double osteotomy). Billing 28296 and 28298 together misrepresents two separate bunionectomy procedures and constitutes duplicate billing.

02Is sesamoidectomy separately billable when performed with 28298?

No. Sesamoidectomy is included in the 28298 work value when performed. The phrase 'when performed' in the descriptor confirms it is bundled — billing it separately will be denied.

03How do I bill bilateral hallux valgus corrections performed at the same session?

Bill 28298 once with modifier 50 for a bilateral procedure, or as two line items with LT and RT modifiers. Check payer preference — Medicare accepts the modifier 50 single-line approach; some commercial payers require separate lines.

04What modifiers apply if the patient returns to the OR during the 90-day global for a wound complication on the same foot?

Use modifier 78 for an unplanned return to the OR for a complication related to the original procedure. Modifier 79 applies only if the return procedure is unrelated to the bunionectomy.

05Does 28298 require a specific ICD-10 code for medical necessity?

M20.10–M20.12 (hallux valgus, unspecified/right/left) are the primary diagnosis codes. Some MACs also require documentation of failed conservative treatment — orthotics, padding, footwear modification — before approving surgical correction.

06Can I bill an E/M visit on the same day as 28298 for a new, unrelated problem identified pre-surgery?

Yes, with modifier 25 on the E/M if the decision for surgery has already been made and the visit addresses a separately identifiable problem. If the E/M drove the decision for surgery that same day, modifier 57 applies instead.

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 osteotomy site (proximal phalanx vs. metatarsal), fixation type and implant details, sesamoidectomy status, and laterality directly from dictation. It flags when both a metatarsal and phalanx osteotomy are described — prompting a review of whether 28299 (double osteotomy) is the correct code rather than 28298 — before the claim is submitted.

See how Mira captures CPT 28298 documentation