Surgical reconstruction of a macrodactyly-affected toe requiring bone resection, with tendon shortening to restore normal digit dimensions and alignment.

Verified May 8, 2026 · 6 sources ↓

Medicare: $647.98
Work RVU: 8.5
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCEmednyCgsmedicareFastrvu

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm diagnosis of macrodactyly with clinical findings; specify which toe and whether unilateral or bilateral involvement
Document that bone resection was performed — not soft tissue alone — to support 28341 over 28340
Name the specific phalanx or phalanges resected (proximal, middle, distal) or note if digit amputation was performed
Document tendon shortening technique and rationale as part of the reconstruction
Record pre-operative functional impairment (pain, footwear inability, gait disturbance) to support medical necessity
Specify laterality (left vs. right foot) and digit number in both the operative note and diagnosis coding

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 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 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 6 cited references ↓

CPT 28341 covers reconstruction of a toe enlarged by macrodactyly when bone resection is required — distinguishing it from 28340, which addresses only soft-tissue resection. The procedure involves removing one or more phalanges, or the entire digit if necessary, combined with tendon shortening to rebalance the reconstructed toe. The goal is functional and dimensional correction, not cosmetic reduction alone.

The 90-day global period applies. All routine post-op visits, wound checks, and dressing changes through day 90 are bundled. If a complication requires an unplanned return to the OR for a related procedure during the global, append modifier 78. An unrelated procedure in the same global window uses modifier 79 instead — do not invert these.

When macrodactyly reconstruction involves both soft-tissue and bone resection during the same operative session, 28341 is the correct code — 28340 is not additionally reportable for the soft-tissue component of the same digit. If multiple toes require reconstruction on the same foot, document each digit separately and apply modifier 51. Bilateral feet on the same date require modifier 50.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (8.5) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (19.4) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	8.5
Practice expense RVU	10.18
Malpractice RVU	0.72
Total RVU	19.4
Medicare national rate	$647.98
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	$647.98
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 28341 get rejected.

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

Billing 28341 and 28340 together for the same digit — bone resection subsumes soft-tissue work on the same toe
Missing or vague operative note that doesn't explicitly confirm bone resection occurred, triggering downcoding to 28340
Laterality mismatch between the ICD-10 diagnosis code and the LT/RT modifier on the claim
Medical necessity not established — no documentation of functional impairment or failed conservative management
Global period violation — post-op E/M visits billed without modifier 24 when unrelated to the macrodactyly reconstruction

Frequently asked questions

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

01What separates 28341 from 28340?

28340 covers macrodactyly reconstruction via soft-tissue resection only. 28341 is the correct code when bone resection — removal of one or more phalanges — is required. If both are performed on the same digit in the same session, bill 28341 only; the soft-tissue component is included.

02Can 28341 and 28340 be billed together for the same toe?

No. When bone resection is performed, 28341 captures the entire reconstruction including any soft-tissue work on that digit. Billing both codes for the same toe will trigger a bundling denial.

03How do you bill if macrodactyly reconstruction is performed on two toes of the same foot?

Report 28341 for each toe with modifier 51 on the lower-value procedure. Document each digit's resection separately in the operative note. Procedure codes within the same CPT family should be listed highest to lowest value for correct adjudication.

04Is modifier 50 appropriate for bilateral macrodactyly reconstruction on the same date?

Yes, if the identical procedure is performed on the same toe of both feet on the same date of service. Apply modifier 50 and confirm your operative note documents bilateral findings and separate resection for each foot. Some payers require LT/RT instead — verify payer preference before submitting.

05What modifier applies if the patient returns to the OR during the 90-day global for a wound complication related to 28341?

Use modifier 78 for an unplanned return to the OR for a procedure related to the original macrodactyly reconstruction. Modifier 79 applies only when the return procedure is completely unrelated to 28341. Inverting these two modifiers is a common and auditable error.

06Does macrodactyly have a specific ICD-10 code to support 28341?

Q74.2 (congenital malformations of toes) and related congenital anomaly codes are commonly paired with 28341. Laterality must be captured in both the diagnosis code and the LT/RT modifier on the claim to avoid a mismatch denial.

07When is modifier 22 justified for 28341?

Modifier 22 is appropriate when the reconstruction required substantially more work than typical — for example, severe multi-phalangeal involvement, prior failed surgery creating scarring and adhesions, or unusual neurovascular anatomy requiring additional dissection. The operative note must quantify the added complexity and time.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the specific digit reconstructed, confirms bone resection type (phalanx removed, level, and extent), documents tendon shortening technique, and records the pre-operative functional deficits driving the indication. This prevents the most common audit flag: operative notes that describe soft-tissue work without explicitly confirming osseous resection, which leads to downcoding to 28340.

See how Mira captures CPT 28341 documentation