Surgical reconstruction of an angular toe deformity using soft tissue techniques only — such as tendon transfers, tendon releases, and capsulotomies — without bony procedures. Typical indications include overlapping second toe, fifth toe, and curly toe deformities.

Verified May 8, 2026 · 7 sources ↓

Medicare: $545.77
Total RVUs: 16.34
Global, days: 90
Region: Foot & ankle

Drawn from CMSNIHPodiatrymGenhealth

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify the exact toe(s) treated by name and number (e.g., second toe, fifth toe) and the corresponding digit modifier (T-codes where payer requires them).
Describe the deformity type explicitly — overlapping, underlapping, curly, or flexible angular — and confirm no osseous procedure was performed.
Name every soft tissue step performed: which tendons were released or transferred, whether capsulotomy was performed, and at which joint (MTP, PIP, DIP).
Document conservative treatment failure prior to surgery, including duration of shoe modification, padding, splinting, or physical therapy.
Record laterality (left/right foot) and document each toe individually if multiple toes are treated on the same date.
If K-wire fixation is used for positional maintenance only (not a bone procedure), note that explicitly to support the soft-tissue-only code selection.

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 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 28313 covers soft-tissue-only reconstruction of angular toe deformities. That means tendon releases, tendon transfers, capsulotomies, and ligament adjustments performed to realign a structurally aberrant toe. The parenthetical examples — overlapping second toe, fifth toe, curly toes — signal that this is the right code when the deformity is flexible and correctable without osteotomy or interphalangeal fusion. If bone work is added, look to 28285 or other osseous toe codes instead.

The code carries a 90-day global period. All routine post-op visits, dressing changes, and suture removals through day 90 are bundled. Anything unrelated in that window requires modifier 24. A staged or planned return for a related soft tissue procedure in the global period uses modifier 58; an unplanned return for a related complication uses modifier 78.

Bundling is the primary billing trap with 28313. Component soft tissue steps — extensor tenotomy, flexor tenotomy, capsulotomy — are included within 28313 when they are part of the same angular deformity correction on the same toe. Billing 28234 or similar tenotomy codes alongside 28313 for the same toe and same deformity will be denied as components of the more comprehensive reconstruction code. Modifier 59 or XS may rescue a distinct procedure on a separately documented different toe, but separate incisions alone are not sufficient justification.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.02
Practice expense RVU	10.62
Malpractice RVU	0.7
Total RVU	16.34
Medicare national rate	$545.77
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	$545.77
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 28313 get rejected.

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

Tendon release or tenotomy billed separately (e.g., 28234) for the same toe on the same date — bundled into 28313 as a component of the comprehensive reconstruction.
Missing laterality modifier or digit modifier when the payer requires T-codes, resulting in claim rejection or edit.
Insufficient documentation of deformity type and soft-tissue steps performed, causing auditors to question whether 28313 is more appropriate than 28285 (which requires bone work).
Routine post-op visit billed without modifier 24 inside the 90-day global period, triggering automatic denial.
Bilateral or multi-toe billing without modifier 50 or 51 and appropriate documentation that each toe represented a distinct deformity correction.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What is the difference between 28313 and 28285 for hammertoe correction?

28313 is soft tissue only — tendon releases, transfers, capsulotomies. 28285 includes osseous work such as interphalangeal fusion or phalangectomy. Use 28313 when the deformity is flexible and corrected entirely without bone procedures. Use 28285 when a bony step is performed. Coding experts have noted 28285 is rarely appropriate without documented bone work.

02Can I bill a tenotomy code like 28234 alongside 28313 for the same toe?

No. Tendon releases and tenotomies performed as part of the angular deformity correction are bundled into 28313. Billing 28234 separately for the same toe on the same date will be denied regardless of whether a separate incision was made. Modifier 59 or XS is only supportable for a distinct procedure on a different toe with separate documentation.

03Which digit modifiers are required when billing 28313?

Medicare uses T-codes (T3–T9 for lesser toes) to identify the specific digit. Some payers accept LT/RT for laterality only. Confirm requirements with each payer — missing digit modifiers are a routine rejection trigger. Technically, T-codes apply to the phalanges; LT/RT applies to the foot overall.

04What global period applies to 28313, and what does it include?

28313 carries a 90-day global period. That covers the surgery date, the day-before pre-op visit if applicable, and all routine post-op care through day 90. Unrelated E/M visits in that window need modifier 24. A new unrelated procedure needs modifier 79. A staged related procedure needs modifier 58.

05Is 28313 appropriate for K-wire fixation used to maintain toe position after soft tissue repair?

Yes, provided the K-wire is used solely for positional maintenance and no formal osteotomy or fusion was performed. Document explicitly that the wire is a stabilization device only. If osseous work was done, 28313 is no longer the right code.

06Can 28313 be billed for multiple toes on the same day?

Yes. Bill 28313 for the primary toe, then 28313-51 for each additional toe corrected in the same session. Append the appropriate digit or laterality modifiers. Document each deformity independently in the operative note — a single sentence covering 'multiple toes' is not sufficient.

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 deformity type (overlapping, underlapping, curly), the specific toe treated with laterality, every soft tissue step performed (tendon release, tendon transfer, capsulotomy, ligament repair), and the explicit absence of bony work. That documentation prevents the two most common audit flags: downcoding to 28285 when no osseous procedure was done, and bundling denials when component tenotomies are billed separately for the same toe.

See how Mira captures CPT 28313 documentation