Surgical osteotomy of the talus (ankle bone) involving incision and realignment to address fractures of the talar body or neck, irreducible dislocations, or chronic ankle instability.

Verified May 8, 2026 · 5 sources ↓

Medicare: $674.03
Work RVU: 9.5
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCCgsmedicareEmedny

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Operative note must name the surgical approach used (e.g., anteromedial, posterolateral) — notes that say only 'standard approach' flag on audit
Preoperative diagnosis with supporting imaging (X-ray, CT, or MRI) identifying the talar pathology requiring osteotomy
Intraoperative description of bone incision, realignment technique, and fixation hardware or method used
Indication clearly documented: talar body/neck fracture, irreducible dislocation, or chronic instability with bony component
Laterality specified (left vs. right) matching the LT or RT modifier on the claim

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 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 28302 covers an open osteotomy of the talus — the surgeon incises or transects the ankle bone and repositions it to correct deformity or restore alignment. Indications include fractures of the talar body or neck that cannot be reduced by closed means, irreducible ankle dislocations, and chronic instability driven by bony malalignment. The approach and fixation method should be explicitly named in the operative note.

This is a 90-day global procedure. All routine post-op care through day 90 — follow-up visits, wound checks, dressing changes — is bundled. Anything unrelated to the talus osteotomy billed in that window requires modifier 24 (E/M) or 79 (unrelated procedure). A return to the OR for a complication directly tied to the original surgery bills with modifier 78.

Site of service matters here. The gap between HOPD and ASC facility payments is substantial — see the Site of Service comparison on this page. Most payers follow Medicare's global period structure, but some commercial contracts define global differently; confirm before billing a post-op visit separately.

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 (9.5) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (20.18) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	9.5
Practice expense RVU	8.66
Malpractice RVU	2.02
Total RVU	20.18
Medicare national rate	$674.03
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	$674.03
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,761.02

Common denial reasons

The recurring reasons claims for CPT 28302 get rejected.

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

Missing or vague laterality in the operative note, mismatched with the LT/RT modifier billed
Post-op E/M visits billed without modifier 24 during the 90-day global period, triggering automatic denial
Medical necessity not established — imaging or clinical documentation doesn't support open osteotomy over closed reduction or conservative management
Bundling conflicts when concomitant ankle procedures are billed same-day without appropriate modifier 59 or XS to establish distinct service
Operative note fails to document the realignment step, leaving only an incision description that may not support the full procedure value

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Does 28302 have a global period, and what does it cover?

Yes — 90-day global. It bundles the day-before preoperative visit, the surgery, and all routine post-op care through day 90. Unrelated E/M visits in that window need modifier 24; unrelated procedures need modifier 79.

02Can 28302 be billed bilaterally?

Bilateral talar osteotomy is extremely rare clinically, but if performed, append modifier 50 and document independent surgical indication for each side. Expect payer scrutiny — have your clinical rationale ready.

03What ICD-10 diagnoses most commonly support 28302?

Talar body and neck fractures (S92.1x series), talar dislocation (S93.0x series), and acquired deformity of the ankle with bony malalignment are the primary supporting diagnoses. The diagnosis must match the documented surgical indication.

04If I perform an ankle arthrodesis at the same session, can I bill both?

Only if the arthrodesis and the osteotomy address anatomically distinct components with separate documentation. Append modifier 51 to the secondary code and confirm the combination isn't subject to an NCCI PTP edit with a modifier indicator of 0, which would prohibit unbundling entirely.

05What modifier covers a return to the OR for hardware failure after 28302?

Modifier 78 covers an unplanned return to the OR for a complication directly related to the original talar osteotomy — for example, hardware failure or wound dehiscence requiring reoperation. Modifier 79 is for an unrelated procedure during the global period. Don't invert these.

06When is modifier 22 appropriate for 28302?

Modifier 22 applies when the procedure is substantially more work than typical — for example, severe comminution requiring extended reconstruction time, prior hardware removal complicating the approach, or significant deformity correction beyond a routine osteotomy. Document the specific factors increasing complexity in the operative note and expect payer review.

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 surgical approach by name, the specific talar pathology addressed (body fracture, neck fracture, or dislocation), the realignment technique, fixation method, and laterality — all from dictation. That prevents the most common audit flag: an operative note that documents the incision but not the repositioning that justifies the osteotomy code.

See how Mira captures CPT 28302 documentation