Surgical resection of excess soft tissue from an abnormally enlarged toe to restore more normal toe dimensions and contour.

Verified May 8, 2026 · 5 sources ↓

Medicare: $557.13
Total RVUs: 16.68
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCCgsmedicareAAOS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Preoperative diagnosis identifying the specific toe and foot, including clinical findings supporting macrodactyly or abnormal enlargement
Operative note naming the affected toe by number (e.g., second toe, left foot) and describing the type and extent of soft tissue resected
Description of the reconstructive technique used, not just 'excision of tissue' — include layers addressed and closure method
Pathology or gross specimen description if tissue is sent for analysis, supporting medical necessity
Documentation of functional impairment or symptoms (pain, difficulty with footwear, gait abnormality) that justify surgical intervention
Laterality clearly stated in both the operative report and the procedure order

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 50 Bilateral procedure 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 5 cited references ↓

CPT 28340 covers operative reduction of a macrodactyly or similarly enlarged toe, where the surgeon removes excess soft tissue — fat, fibrous tissue, or other hypertrophied structures — to bring the toe to proportionate size. This is a reconstructive procedure, not a simple excision; the operative note must reflect the extent of tissue removed, the structures involved, and the reconstructive intent.

The code carries a 90-day global period. All routine follow-up, wound checks, and suture removal through day 90 are bundled. If you're managing a separately arising condition in that window, append modifier 24 to the E/M. If an unrelated procedure is performed during the global, use modifier 79. A return to the OR for a related complication uses modifier 78.

Laterality matters here. Bill with modifier LT or RT to identify the affected foot. If bilateral enlargement is corrected in one operative session — uncommon but possible — modifier 50 applies. Document each toe by number and foot in the operative note; vague references to 'the affected toe' invite audits and payer denials.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.97
Practice expense RVU	9.12
Malpractice RVU	0.59
Total RVU	16.68
Medicare national rate	$557.13
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	$557.13
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 28340 get rejected.

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

Missing or ambiguous laterality — payer cannot confirm LT or RT without explicit documentation in the operative note
Medical necessity not established — no documented functional impairment or conservative treatment failure prior to surgery
Operative note too vague to distinguish 28340 from simpler soft tissue excision codes, triggering downcoding or denial
Unbundling errors when concurrent toe procedures are billed without appropriate modifiers to justify separate reporting
Global period conflict — post-op E/M billed without modifier 24 or 25 during the 90-day window

Frequently asked questions

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

01What is the global period for CPT 28340?

90 days. Routine post-op visits, wound checks, and suture removal through day 90 are all bundled. Use modifier 24 on any E/M for an unrelated condition during that window.

02Do I need modifier LT or RT when billing 28340?

Yes. Always append LT or RT to identify the operative foot. Missing laterality is a top denial driver for foot and toe codes across most payers.

03Can 28340 and 28341 be billed together?

28341 covers a more involved macrodactyly repair with bone work. If both soft-tissue and osseous components are addressed in the same toe, review NCCI edits before billing both — append modifier 59 or XS only if the procedures are truly distinct and documentation supports it.

04What ICD-10 codes support medical necessity for 28340?

Macrodactyly (Q74.2 for limb reduction defects involving the foot, or the appropriate congenital digit anomaly code) and acquired soft-tissue hypertrophy of the toe are the primary diagnoses. Confirm with your payer's LCD; some require documented conservative treatment failure before approving elective reconstruction.

05Is 28340 payable in an ASC setting?

Yes. CMS assigns 28340 an ASC payment rate distinct from the HOPD facility rate — see the Site of Service comparison table on this page. Confirm the procedure is on your ASC's covered procedures list before scheduling.

06What modifier applies if the patient returns to the OR for a wound complication during the global period?

Modifier 78 — unplanned return to the OR for a complication related to the original procedure. Do not use modifier 79 (that's for an unrelated procedure) or 58 (that's for a planned staged procedure).

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 affected toe number, foot laterality, tissue types resected, extent of enlargement, reconstructive technique, and closure method directly from dictation. That prevents the two most common audit flags for 28340: operative notes that name only 'the enlarged toe' without specifying laterality, and notes that read as simple excision rather than soft-tissue reconstruction — both of which invite downcoding or outright denial.

See how Mira captures CPT 28340 documentation