Surgical repair of a metatarsal nonunion or malunion, with or without bone graft; graft harvest is included when performed.

Verified May 8, 2026 · 8 sources ↓

Medicare: $813.98
Total RVUs: 24.37
Global, days: 90
Region: Foot & ankle

Drawn from NIHAAPCCMSAacpm

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Operative note must explicitly identify the condition as a nonunion or malunion — not a fresh fracture — with prior imaging (X-ray, CT, or MRI) confirming failed or malaligned healing.
Document which metatarsal(s) were repaired and laterality (left, right, or bilateral).
If bone graft was harvested, document the donor site, graft type (autograft, allograft), and volume; this is bundled but must appear in the op note.
Specify fixation method: screws, plates, pins, or combination, with implant details as required by facility.
Include clinical history showing prior fracture or osteotomy with documented time elapsed and failure to achieve radiographic union.
If performed during an existing global period, document the clinical rationale supporting modifier 78 (related) or 79 (unrelated).

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

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

CPT 28322 covers open repair of a metatarsal that has failed to heal (nonunion) or healed in malalignment (malunion) after a prior fracture or osteotomy. The procedure includes bone realignment, internal fixation with screws, plates, or pins, and — when clinically necessary — harvest and placement of autogenous bone graft. Graft harvest is bundled into the code; do not separately report 20900 or 20902 when graft is taken at the same session.

This is not a fresh-fracture code. If you're billing for initial open treatment of an acute metatarsal fracture, 28485 (lesser metatarsal) or 28505 (hallux) applies. Use 28322 only when the operative note documents a previously established nonunion or malunion — a distinction auditors and payers enforce. The code carries a 90-day global period, so routine post-op visits through day 90 are bundled.

Common scenarios include failed ORIF of a 5th metatarsal base fracture (Jones fracture nonunion), first metatarsal osteotomy that did not consolidate, and stress fracture nonunion in athletes. When the repair is performed during the global period of a prior related procedure, append modifier 78. If it's performed during a global period for an unrelated procedure, use modifier 79.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	8.32
Practice expense RVU	14.74
Malpractice RVU	1.31
Total RVU	24.37
Medicare national rate	$813.98
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	$813.98
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,734.49

Common denial reasons

The recurring reasons claims for CPT 28322 get rejected.

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

Code billed for an acute fracture repair — payers reclassify to 28485 or 28505 when operative note lacks nonunion or malunion language.
Missing laterality modifier (LT or RT) — BCBS and some regional payers deny without it; bilateral cases require modifier 50 or separate line items per payer policy.
Bone graft harvest billed separately (20900/20902) when graft is obtained at the same operative session — bundled into 28322 by NCCI.
Repair performed during a 90-day global period of a prior related procedure billed without modifier 78, triggering global-period denial.
Insufficient imaging documentation — payers require pre-op radiographic evidence of nonunion or malunion to authorize and adjudicate the claim.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01What is the difference between CPT 28322 and CPT 28485?

28485 covers open treatment of an acute lesser metatarsal fracture. 28322 is for a metatarsal nonunion or malunion — a previously fractured or osteotomized bone that failed to heal or healed out of alignment. The distinction is clinical and must be documented; payers will reclassify 28322 to 28485 if the op note reads like an acute fracture repair.

02Is bone graft harvest separately billable with 28322?

No. When autogenous graft is harvested at the same operative session, it is bundled into 28322. The code descriptor specifically includes obtaining the graft. Billing 20900 or 20902 separately will trigger an NCCI edit and denial.

03Which modifier applies if 28322 is performed during the global period of a prior foot surgery?

Use modifier 78 if returning to the OR for a complication or issue related to the prior procedure. Use modifier 79 if the nonunion repair is unrelated to the index procedure. Do not invert these — modifier 78 is for related returns, 79 for unrelated procedures during a global period.

04Does 28322 require a laterality modifier for Medicare?

Medicare does not universally require LT/RT for foot procedures the way it does for paired organs, but many commercial payers — including BCBS plans — deny 28322 without a laterality modifier. Appending LT or RT (or 50 for bilateral) is best practice across all payers.

05Can 28322 be billed with a first MTP fusion (28750) on the same day?

Yes, if performed on the same foot, both codes can be reported together — append modifier 51 to the lower-value code. The op note must clearly support both procedures as distinct, with separate indications. This combination appears in AAPC forum guidance for nonunion repair plus MTP arthrodesis with hardware removal.

06What imaging supports medical necessity for 28322?

Pre-operative X-rays or CT scan showing failure of bony bridging at the fracture or osteotomy site are the standard. CT is increasingly required by payers for Jones fracture nonunion cases. Include imaging dates and findings in the pre-op documentation — vague references to 'continued pain' without radiographic nonunion evidence are a common denial trigger.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

The Mira AI Scribe captures the surgeon's dictation of the specific metatarsal involved, the documented nonunion or malunion diagnosis with reference to prior imaging, fixation hardware used, and whether bone graft was harvested and from which donor site. This prevents the most common denial — a payer reclassifying the claim to a fresh-fracture code because the operative note lacked explicit nonunion or malunion language.

See how Mira captures CPT 28322 documentation