Osteotomy of the tarsal bones (excluding calcaneus and talus) with autograft harvest and placement to correct midfoot deformity or stabilize the bone architecture.

Verified May 8, 2026 · 5 sources ↓

Medicare: $625.26
Total RVUs: 18.72
Global, days: 90
Region: Foot & ankle

Drawn from AAPCEmednyAacpmCMS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Identify the specific tarsal bone(s) osteotomized — navicular, cuboid, or cuneiform(s) — and confirm neither calcaneus nor talus is the osteotomy site
Document that autograft was harvested, including the harvest site (local vs. distant) and method, confirming it is not billed separately
State the clinical indication explicitly: tarsal coalition, cavus foot deformity, nonunion, or other structural pathology requiring bone realignment
Describe the fixation method used (screws, staples, plates) and confirm the graft was placed to fill the osteotomy gap
Record pre-operative imaging (weight-bearing X-rays or CT) confirming the deformity or pathology that necessitated osteotomy with grafting
Note intraoperative fluoroscopy use if applicable; document separately only if it meets independent reporting criteria under applicable payer policy

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 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 28305 describes a tarsal bone osteotomy — a surgical cut through one or more of the midfoot bones, excluding the calcaneus and talus — combined with autogenous bone grafting. The autograft harvest is included in the code; you cannot bill it separately regardless of whether the graft is harvested locally through the same incision or from a distant site. The procedure is used for structural deformities such as tarsal coalition, cavus foot correction, or situations requiring bone realignment and gap-filling to achieve stable union.

The 90-day global period covers all routine post-op care from the day before surgery through day 90. Any E/M visit for an unrelated condition during that window requires modifier 24. A staged or planned return to the OR for a related procedure uses modifier 78; an unrelated return-to-OR procedure uses modifier 79. Do not invert those two.

Code 28305 sits one step above its sibling 28304 (tarsal osteotomy without graft). If the operative note documents bone grafting but the coder bills 28304, the difference in work is left on the table. Conversely, billing 28305 without clear documentation of autograft harvest and placement will draw a medical necessity denial. Nail the operative note specifics before submitting.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.5
Practice expense RVU	6.7
Malpractice RVU	1.52
Total RVU	18.72
Medicare national rate	$625.26
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	$625.26
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,952.96

Common denial reasons

The recurring reasons claims for CPT 28305 get rejected.

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

Operative note fails to document autograft harvest — payer downcodes to 28304 (tarsal osteotomy without graft)
Medical necessity not established — missing pre-op imaging or inadequate documentation of deformity severity and conservative treatment failure
Autograft harvest billed separately as an additional code, triggering a bundling edit since obtaining the graft is included in 28305
Calcaneus or talus listed as the operative bone — those osteotomies have distinct codes (28300 and 28302 respectively) and miscoding triggers rejection
Bilateral procedure billed on two separate claim lines without modifier 50, causing one line to deny as a duplicate

Frequently asked questions

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

01Can I bill the bone graft harvest separately when performing a 28305?

No. The autograft — including obtaining it — is bundled into 28305 whether the graft is harvested locally through the same incision or from a separate distant site. Billing a separate graft harvest code will trigger a bundling denial.

02What is the difference between 28304 and 28305?

28304 is a tarsal osteotomy without bone graft. 28305 is the same procedure performed with autograft. If the operative note documents graft placement, bill 28305 — billing 28304 understates the work performed and leaves reimbursement uncaptured.

03Does 28305 cover osteotomies of the calcaneus or talus?

No. Calcaneal osteotomy is 28300; talar osteotomy is 28302. CPT 28305 applies only to the remaining tarsal bones: navicular, cuboid, and the three cuneiforms.

04How do you bill 28305 when performed bilaterally in the same operative session?

Append modifier 50 to 28305 on a single claim line. Medicare reimburses bilateral procedures at 150% of the single-procedure allowable. Do not submit two separate claim lines without modifier 50 — it reads as a duplicate.

05What modifier applies if the surgeon returns to the OR within the 90-day global for a complication related to the original 28305?

Use modifier 78 for an unplanned return to the OR for a procedure directly related to the original surgery. Modifier 79 is for a return to the OR for a completely unrelated procedure. Inverting these is a common audit finding.

06Can 28305 and a midfoot arthrodesis code (e.g., 28740) be billed together?

Only if distinct anatomic sites are addressed and supported by operative documentation. NCCI edits apply — check the current NCCI table for the specific code pair. Modifier 59 or XS may be required to bypass a bundling edit when the procedures are genuinely separate.

07What ICD-10 diagnoses typically support medical necessity for 28305?

Tarsal coalition (Q66.89), acquired flatfoot deformity (M21.4X), cavus foot deformity (M21.6X), and midfoot malunion or nonunion following prior fracture are the most common supporting diagnoses. The diagnosis must match the documented clinical indication in the pre-op workup.

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 specific tarsal bone(s) cut, the autograft harvest site and technique, the fixation construct, and the clinical indication driving the osteotomy — all from your dictation. That prevents the most common 28305 denial: a note that documents the osteotomy but omits explicit graft harvest detail, prompting a payer to downcode to 28304 and recover the difference on audit.

See how Mira captures CPT 28305 documentation