Surgical osteotomy of the first metatarsal (shaft or base) excluding the metatarsophalangeal joint surface, performed to correct deformity, relieve pain, or address shortening — with or without bone graft.

Verified May 8, 2026 · 5 sources ↓

Medicare: $844.71
Total RVUs: 25.29
Global, days: 90
Region: Foot & ankle

Drawn from CMSCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify which metatarsal is involved and confirm it is not the articular surface being addressed
Identify the surgical indication: angular deformity, shortening, structural malalignment, or pain with radiographic correlation
Document whether autogenous bone graft was performed and the harvest site if applicable
Confirm the procedure is not performed on the ipsilateral first toe or metatarsal concurrently with a bunionectomy (28291–28299)
Record intraoperative fluoroscopy use if performed — note it is integral and not separately billable
Document laterality (right vs. left foot) in both the operative report and the encounter header

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 52 Reduced services 58 Staged or related 59 Distinct service 74 Discontinued post-anesthesia 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 5 cited references ↓

CPT 28307 covers an osteotomy of the first metatarsal performed to correct angular deformity, shortening, or structural malalignment not addressed by the metatarsophalangeal joint articulation itself. The procedure may include autogenous bone graft when shortening requires structural augmentation. It sits in a 90-day global period, meaning all routine follow-up through day 90 is bundled — separate E/M visits in that window require modifier 24 for unrelated encounters.

The most critical billing boundary for 28307 is its hard exclusion from same-day bunionectomy codes (28291–28299) on the ipsilateral first toe or metatarsal. NCCI policy is explicit: bunionectomy codes that include first metatarsal osteotomy already capture what 28307 describes, making the combination a misuse of 28307. Reporting both will deny the column-two code without an allowable modifier pathway — no modifier overrides this edit. If the osteotomy is performed on a different metatarsal or at a separate anatomic site, document that distinction with specificity.

Site of service matters here. HOPD and ASC payments differ substantially (see the Site of Service comparison table). When the procedure is performed bilaterally — uncommon but possible in reconstructive cases — append RT and LT, not modifier 50, since bilateral foot procedures are typically reported on two lines with the appropriate laterality modifiers.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.34
Practice expense RVU	17.61
Malpractice RVU	1.34
Total RVU	25.29
Medicare national rate	$844.71
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	$844.71
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 28307 get rejected.

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

NCCI bundle denial when 28307 is reported same-day with bunionectomy codes 28291–28299 on the ipsilateral foot — no modifier bypasses this edit
Missing or vague laterality documentation causing claim-level mismatch with RT/LT modifiers
Insufficient operative note detail on deformity type or graft use, triggering medical necessity denial
Upcoding flag when 28307 is billed for a procedure that falls within the descriptor of a comprehensive bunionectomy already performed

Frequently asked questions

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

01Can I bill 28307 alongside a bunionectomy on the same foot?

No. NCCI policy explicitly prohibits reporting 28307 with bunionectomy codes 28291–28299 on the ipsilateral first toe or metatarsal. The modifier indicator for this edit does not allow a bypass modifier. If the osteotomy is on a different metatarsal and clearly documented as a separate anatomic site, the clinical rationale must be unambiguous in the operative report.

02Does 28307 include fluoroscopic guidance?

Yes. Intraoperative fluoroscopy is integral to the procedure and cannot be separately billed. Do not append a fluoroscopy or radiologic guidance code to 28307 on the same date of service.

03What global period applies to 28307?

28307 carries a 90-day global period. All routine post-op visits, dressing changes, and suture removals through day 90 are bundled. Use modifier 24 for unrelated E/M visits and modifier 79 for an unrelated procedure performed during the global window.

04How do I bill 28307 when the procedure is performed on both feet at the same encounter?

Report 28307 on two lines with RT on one and LT on the other. Do not use modifier 50 for bilateral foot procedures — laterality modifiers are the correct approach here and avoid automated bilateral-reduction edits.

05Is bone graft separately reportable when performed with 28307?

When bone graft is explicitly included in the procedure (autogenous graft for shortening correction), it is bundled into 28307. Check whether a separate graft harvest code is applicable based on the site and extent — document the harvest site and technique with enough specificity to support any additional code if billed.

06What ICD-10 diagnoses typically support 28307?

Diagnoses supporting 28307 generally include metatarsus primus varus, acquired or congenital first metatarsal deformity, shortening deformity of the first metatarsal, or structural forefoot malalignment with radiographic documentation. Payers expect imaging correlation in the record.

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 metatarsal operated on, the deformity type corrected, whether bone graft was harvested and from where, and explicit confirmation that no concurrent bunionectomy was performed on the ipsilateral first toe. That documentation prevents the most common 28307 denial: an NCCI bundling rejection when auditors cannot verify the procedure was anatomically distinct from a same-day bunionectomy.

See how Mira captures CPT 28307 documentation