Osteotomy of a lesser metatarsal (any metatarsal except the first), with optional lengthening, shortening, or angular deformity correction, performed per bone.

Verified May 8, 2026 · 6 sources ↓

Medicare: $585.52
Total RVUs: 17.53
Global, days: 90
Region: Foot & ankle

Drawn from CMSMedicare.govAAPCTldsystemsPodiatrym

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify which metatarsal(s) were cut — second, third, fourth, or fifth — by number, not just 'lesser metatarsal'
Document the specific osteotomy technique by name (e.g., Weil, chevron, oblique) — notes that say 'standard osteotomy' draw audit flags
State whether lengthening, shortening, or angular correction was performed, or document realignment-only if no net length change
Document the clinical indication: metatarsalgia, transfer lesion, hammertoe deformity, bunionette, or metatarsus adductus
Record fixation method used — screw, K-wire, or none — and confirm position on intraoperative imaging if fluoroscopy was used
For same-day multi-procedure cases, document each procedure in a separate operative paragraph with its own indication and technique

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 28308 covers a surgical osteotomy of any metatarsal other than the first — second through fifth — to realign the bone and correct forefoot deformity. The procedure applies whether the surgeon lengthens, shortens, or angularly corrects the metatarsal, or simply cuts it for realignment. Common clinical indications include lesser metatarsal overload, metatarsalgia, hammertoe-associated metatarsal deformity, bunionette correction with osteotomy, and metatarsus adductus. Weil osteotomy of the second metatarsal is a frequent real-world application.

The code is reported per bone. If two lesser metatarsals are cut during the same session, use 28308 for the first and 28309 (multiple metatarsal osteotomies) may be the more appropriate code for three or more — confirm with your payer. When performed same-day as a Lapidus bunionectomy (28297) or first metatarsal procedure, 28308 is not bundled via NCCI and can be reported separately without modifier 59, as long as the clinical scenario supports independent procedures. Modifier 59 appended to a simultaneously billed hammertoe arthroplasty (28285) is unnecessary and may trigger a rejection — those two codes are not NCCI-bundled.

28308 carries a 90-day global period. All routine follow-up, dressing changes, and related post-op visits are included through day 90. Use modifier 24 for unrelated E/M visits and modifier 78 for an unplanned return to the OR for a related complication within the global window. Staged or planned secondary procedures use modifier 58.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.34
Practice expense RVU	11.51
Malpractice RVU	0.68
Total RVU	17.53
Medicare national rate	$585.52
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	$585.52
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 28308 get rejected.

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

Modifier 59 appended incorrectly to 28285 billed same-day, causing 28308 to reject as unbundled when no bundle exists
Operative note documents only 'lesser metatarsal osteotomy' without specifying which metatarsal, failing medical necessity review
Capsulotomy (28270) billed separately on same day — payers bundle capsular work as integral to the osteotomy approach and closure
28308 billed multiple units for multiple metatarsals instead of using 28309 for three or more, triggering MUE edits
Missing preoperative clinical documentation (failed conservative treatment, imaging with deformity measurement) required for medical necessity

Frequently asked questions

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

01Can 28308 be billed with 28297 (Lapidus) on the same day?

Yes. 28297 addresses the first metatarsocuneiform joint; 28308 addresses a lesser metatarsal. They are not NCCI-bundled. Bill both with the appropriate laterality modifier — no modifier 59 needed to unbundle them.

02How do I bill when two lesser metatarsals are cut in the same session?

28308 is a per-bone code. For two metatarsals, report 28308 twice with modifier 51 on the second unit. For three or more, 28309 (multiple metatarsal osteotomies) may be the correct code — verify with your payer, as some require 28309 at three or more.

03Is modifier 59 needed when billing 28308 alongside 28285 (hammertoe arthroplasty)?

No. These two codes are not in an NCCI bundle pair. Adding modifier 59 to 28285 to 'unbundle' them is incorrect and can cause 28308 to reject. Bill each code with the appropriate toe-level or laterality modifier only.

04Does 28308 cover a Weil osteotomy?

Yes. The Weil osteotomy of the second, third, fourth, or fifth metatarsal is reported with 28308. The code covers the osteotomy regardless of the specific technique used, as long as it's on a lesser metatarsal.

05What modifier applies if the patient returns to the OR within the 90-day global for a wound complication at the osteotomy site?

Use modifier 78 — unplanned return to the OR for a procedure related to the original surgery within the global period. Do not use modifier 79, which is for unrelated procedures.

06Can the capsulotomy be billed separately when performed as part of the osteotomy approach?

Generally no. Payers consider capsular incision and closure integral to accessing the metatarsal for the osteotomy. Separate billing of 28270 same-day is routinely denied unless the capsular work was substantially beyond what the osteotomy required and is documented as such.

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 number, osteotomy technique by name, corrective intent (lengthening, shortening, angular correction, or realignment only), fixation method, and fluoroscopic confirmation from dictation. For multi-procedure forefoot cases, it flags each procedure as a discrete operative event with its own indication — preventing the bundling denials that result when a note reads as a single continuous surgery.

See how Mira captures CPT 28308 documentation