Osteotomy of the first metatarsal at the base or shaft, with or without lengthening, shortening, or angular correction — for conditions other than hallux valgus or bunion.

Verified May 8, 2026 · 6 sources ↓

Medicare: $628.27
Total RVUs: 18.81
Global, days: 90
Region: Foot & ankle

Drawn from CMSTldsystemsAAPC

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify the diagnosis driving the osteotomy — document that the indication is NOT hallux valgus or bunion correction, which have dedicated codes.
Name the specific osteotomy technique performed (e.g., opening wedge, closing wedge, oblique shaft) and the anatomical site (base vs. shaft of first metatarsal).
Document whether lengthening, shortening, or angular correction was performed as part of the procedure.
Record laterality (right vs. left foot) explicitly in the operative note and diagnosis coding.
If billing with another foot code same-day, document the distinct anatomical site of each procedure to support modifier 59 or XS.
Include pre-operative imaging (weight-bearing X-rays) confirming the deformity requiring surgical correction.

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 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 6 cited references ↓

CPT 28306 describes a surgical osteotomy of the first metatarsal (base or shaft), which may include lengthening, shortening, or angular correction as part of the same operative session. This code is specifically for non-bunion indications — if the osteotomy is performed to correct hallux valgus, the correct code is a bunionectomy code from the 28291–28299 range (e.g., 28296 for Mitchell or Chevron osteotomy). Billing 28306 for a hallux valgus correction is a direct NCCI policy violation per the 2026 CMS NCCI Manual Chapter 4.

The 90-day global period covers all routine post-op visits, wound care, and related services through day 90. Unrelated E/M visits in that window need modifier 24; a same-day E/M decision for surgery needs modifier 57. NCCI bundles 28306 into bunionectomy codes 28291–28299 when performed on the ipsilateral first toe or metatarsal — modifier 59 or XS can override the edit only when the osteotomy is performed at a genuinely distinct anatomical site (e.g., distal first metatarsal osteotomy combined with a proximal tarsometatarsal arthrodesis). Same-day billing with 28122 on the same foot requires careful modifier strategy; some payers — including certain BCBS plans — prefer XS over 59 to document separate structure.

Place of service matters for reimbursement. The HOPD and ASC facility payments differ substantially; see the Site of Service comparison table. Laterality modifiers LT and RT are standard for all unilateral foot procedures and are expected by Medicare and most commercial payers.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.85
Practice expense RVU	12.14
Malpractice RVU	0.82
Total RVU	18.81
Medicare national rate	$628.27
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	$628.27
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 28306 get rejected.

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

Bundled into bunionectomy code (28291–28299) when performed on the ipsilateral first metatarsal — NCCI Chapter 4 explicitly prohibits separate reporting in this scenario.
Incorrect code selection: 28306 used for hallux valgus/bunion correction instead of the appropriate 28296 or other bunionectomy code.
Missing or incorrect laterality modifier (LT/RT) required by Medicare and most commercial payers for unilateral foot procedures.
Modifier 59 rejected when billing with 28122 same-day on the same foot — payer may require XS instead to document separate anatomical structure.
Lack of documentation distinguishing the osteotomy indication from bunion pathology, triggering medical necessity denial.

Frequently asked questions

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

01Can I bill 28306 for a Mitchell osteotomy correcting hallux valgus?

No. Mitchell osteotomy for hallux valgus correction belongs under 28296. CPT 28306 is reserved for first metatarsal osteotomies performed for conditions other than hallux valgus or bunion. The NCCI 2026 manual explicitly bars reporting 28306 with bunionectomy codes 28291–28299 on the ipsilateral first toe or metatarsal.

02Can 28306 and 28740 be billed together on the same day?

28740 is the Column 1 code and 28306 is Column 2 in the NCCI edit pair. They can be billed together only when performed at anatomically distinct sites — for example, distal first metatarsal osteotomy (28306) combined with a proximal tarsometatarsal arthrodesis (28740). Append modifier 59 to 28306 and document the separate sites in the operative note.

03What modifier applies when 28306 and 28122 are billed same-day on the same foot?

Append modifier 59 (distinct procedural service) to 28306 when the osteotomy and the partial ostectomy under 28122 are performed on different metatarsals. Some payers — particularly BCBS plans — prefer modifier XS (separate structure) as more specific. If 59 or XS denials persist, appeal with operative documentation clearly identifying separate anatomical sites.

04Is 28306 subject to a global period, and what does that mean for post-op billing?

Yes, 28306 carries a 90-day global period. All routine post-operative visits, dressings, and related services are included through day 90. Bill unrelated E/M visits with modifier 24. If you're billing an E/M the day of or day before surgery as the decision-making visit, append modifier 57.

05Should modifier 50 or LT/RT be used for bilateral first metatarsal osteotomies?

Use LT and RT on separate line items rather than modifier 50 unless your payer specifically requires 50 for bilateral foot procedures. Medicare and most commercial payers process bilateral foot/toe procedures by separate laterality modifiers. Confirm payer preference before submitting — some payers auto-deny 50 on foot codes.

06Does the place of service affect reimbursement for 28306?

Yes, significantly. HOPD and ASC facility payments differ substantially — see the Site of Service comparison table on this page. The physician professional fee also varies by site of service under the CMS Physician Fee Schedule 2026, with a lower non-facility RVU typically applying in the office setting where this procedure is rarely performed.

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 technique, anatomical site (base vs. shaft), laterality, and the clinical indication from dictation — specifically flagging whether the diagnosis is hallux valgus or a non-bunion condition. This prevents the most common denial for 28306: upcoding a bunion correction that should be billed under 28296 or another bunionectomy code, which NCCI policy explicitly prohibits billing alongside 28306 on the ipsilateral foot.

See how Mira captures CPT 28306 documentation