Surgical correction of supernumerary toe(s), including removal or reconstruction of the extra digit to restore normal foot anatomy and function.

Verified May 8, 2026 · 5 sources ↓

Medicare: $410.16
Work RVU: 4.29
Global, days: 90
Region: Foot & ankle

Drawn from CMSFastrvuAAPCMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Diagnosis of polydactyly or supernumerary digit with ICD-10 code specifying laterality and toe affected
Operative note describing digit anatomy — whether bony involvement, shared metatarsal, or soft tissue only
Documentation of functional impairment or symptoms (pain, difficulty with footwear, gait abnormality) supporting medical necessity
Pre-op imaging (X-ray) documenting skeletal anatomy of the extra digit when bone resection is performed
If modifier 22 is appended, operative note must quantify why work exceeded typical — complexity of bony union, vascular anatomy, or prior failed repair

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 52 Reduced services 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 5 cited references ↓

CPT 28344 covers surgery to repair or remove an extra toe — most commonly performed for polydactyly of the foot. The procedure may involve soft tissue excision, bone resection, or reconstruction depending on how the extra digit is formed and attached. Both simple (soft tissue only) and complex (osseous involvement) presentations fall under this single code, which means operative note detail is critical for supporting medical necessity and any modifier 22 claim for unusual complexity.

The code carries a 90-day global period. That window includes the day-before visit, the operative day, and all routine post-op care through day 90. Wound checks, suture removal, and routine follow-up are bundled. Bill modifier 24 for unrelated E/M visits and modifier 79 for unrelated procedures performed by the same physician during the global period.

Laterality modifiers LT and RT are required when the procedure is unilateral. If polydactyly affects both feet and you're operating on both in the same session, bill modifier 50 on a single line. Payers vary on whether bilateral polydactyly repair is covered in a single session — verify prior authorization requirements before scheduling.

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 (4.29) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (12.28) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	4.29
Practice expense RVU	7.62
Malpractice RVU	0.37
Total RVU	12.28
Medicare national rate	$410.16
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	$410.16
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 28344 get rejected.

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

Cosmetic exclusion applied when documentation lacks functional impairment — symptom narrative is essential
Missing laterality modifier (LT or RT) triggering claim suspension or rejection
ICD-10 code mismatch — using a non-specific congenital anomaly code when payer requires specific polydactyly code with laterality
Unbundled soft tissue excision codes billed separately when included in the reconstructive repair
Lack of prior authorization for procedures payers classify as potentially cosmetic

Frequently asked questions

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

01Does 28344 cover both simple (soft tissue only) and complex (bony) polydactyly repair?

Yes. 28344 is the single code for extra toe repair regardless of whether the procedure involves soft tissue only or includes bone resection. If the complexity significantly exceeds what is typical — for example, a fully formed duplicate ray with shared metatarsal requiring osteotomy — document the additional work thoroughly and consider modifier 22.

02How do you bill bilateral polydactyly repair performed in the same session?

Bill 28344 with modifier 50 on a single line. Some payers want two lines with LT and RT instead — check your payer contract. Always verify prior authorization, because many payers require it when both feet are addressed simultaneously.

03What happens if the patient returns to the OR for a wound complication during the 90-day global period?

If the return is for a complication directly related to the original polydactyly repair, use modifier 78. If you're performing a completely unrelated procedure during the global period, use modifier 79. Do not invert these — using 79 for a related complication is an audit red flag.

04Which ICD-10 codes pair with 28344?

The primary pairing is Q69.2 (accessory toe(s)). Codes from the Q69 family should specify laterality where possible. Using an overly generic congenital anomaly code without specificity is a leading cause of payer mismatch denials for this procedure.

05Can 28344 be denied as cosmetic, and how do you prevent it?

Yes — payers routinely apply cosmetic exclusions when the operative and clinical notes don't document functional impairment. Record pain, difficulty wearing standard footwear, gait abnormality, or recurrent skin breakdown explicitly. A note that only describes appearance provides no defense against a cosmetic denial.

06Is modifier 52 ever appropriate for 28344?

Modifier 52 applies when the procedure is deliberately reduced in scope — for example, a partial soft tissue excision where full reconstruction was planned but not completed. Per AAPC forum guidance, modifier 52 has been used in revision-of-amputation scenarios involving accessory epiphysis where a lesser service was rendered.

Sources & references

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

01CMS Physician Fee Schedule 2026
02
fastrvu.com
https://fastrvu.com/cpt/28344
03
aapc.com
https://www.aapc.com/codes/cpt-codes/28344
04
mdclarity.com
https://www.mdclarity.com/cpt-code/28344
05
cms.gov
https://www.cms.gov/files/document/2025nccimedicarepolicymanualcompletepdf.pdf

Mira Scribe

Mira's AI scribe captures the operative approach from dictation — digit number and foot side, whether bony resection was performed, metatarsal involvement, closure technique, and any documentation of functional symptoms that establish medical necessity. That prevents the two most common denials for 28344: cosmetic exclusion from thin operative notes and missing laterality that stalls claims at edit.

See how Mira captures CPT 28344 documentation