Surgical reconstruction of toe syndactyly (webbing between toes), with or without skin grafting, reported per web space corrected.

Verified May 8, 2026 · 4 sources ↓

Medicare: $502.68
Total RVUs: 15.05
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPC

Documentation requirements

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

Source · Editorial brief grounded in 4 cited references ↓

Specify which web space(s) were released (e.g., first/second, second/third interdigital space) — 'webbed toes' alone is insufficient for audit defense.
Document whether skin grafting was required, the graft source, and size, if applicable.
Record the degree of syndactyly (simple cutaneous vs. complex with bony or nail involvement) and functional impairment (gait disturbance, shoe-fitting difficulty, digital contracture).
Operative note must confirm each separately billed web space was a distinct surgical site, supporting any modifier 59 appended for multiple webs.
Pre-operative diagnosis must map to a specific ICD-10 code for syndactyly (Q70 series) or acquired webbing to establish medical necessity and rebut cosmetic-exclusion denials.
Document prior conservative measures attempted or explain why surgery is the appropriate first-line intervention.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 59 Distinct service LT Left side RT Right side 78 Unplanned return — related 79 Unrelated during global 24 Unrelated E/M during global 25 Significant separate E/M 52 Reduced services

What this code covers

Source · Editorial summary grounded in 4 cited references ↓

CPT 28345 covers surgical separation of congenitally or traumatically webbed toes, including any skin grafting required to achieve closure of each web space. The procedure is reported per web — if two adjacent web spaces are released in the same operative session, bill 28345 twice with modifier 59 to establish that distinct, separate web spaces were addressed. The code falls in the Repair, Revision, and/or Reconstruction section for the foot and toes.

The 90-day global period means all routine post-op visits, wound checks, and dressing changes through day 90 are bundled. New problems arising in the global window require modifier 24 (E/M) or modifier 79 (unrelated surgical procedure) to break out of the global. Graft harvest, when performed, is typically included in the primary reconstruction — do not separately bill donor-site closure codes unless the harvest constitutes a distinct, separately reportable service at a different anatomic location.

Payer variability is real here: some commercial plans classify syndactyly repair as cosmetic when the webbing is simple and non-functional, requiring thorough documentation of functional impairment, gait abnormality, shoe-fitting difficulty, or digital contracture to support medical necessity. Medicaid coverage is plan-dependent; prior authorization is standard.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.94
Practice expense RVU	8.62
Malpractice RVU	0.49
Total RVU	15.05
Medicare national rate	$502.68
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	$502.68
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 28345 get rejected.

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

Cosmetic exclusion: payer deems simple cutaneous syndactyly without documented functional impairment non-covered — requires specific functional findings in the record.
Unbundling denial when 28345 is billed multiple times without modifier 59 or adequate documentation distinguishing separate web spaces.
Missing or inadequate prior authorization — most commercial and Medicaid plans require pre-auth for this elective reconstructive procedure.
ICD-10 mismatch: using an unspecified or incorrect syndactyly code (Q70 subcategory) that does not match the operative site documented.
Global period violation: post-op E/M billed without modifier 24 when the visit falls within the 90-day global window.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 4 cited references ↓

01Can I bill 28345 twice if I release two web spaces in the same session?

Yes. Bill 28345 for each web space released. Append modifier 59 to the second unit and document each web space by name in the operative note. Without that documentation, expect an unbundling denial on the second unit.

02Is skin grafting separately billable when performed with 28345?

Generally no — grafting required to close the web space release is considered part of the reconstruction. Separate graft codes are only supportable if a distinct donor-site procedure at a separate anatomic location is performed and documented as independently identifiable.

03What ICD-10 codes support 28345?

The Q70 category covers syndactyly. Code to the specific digit(s) and laterality: Q70.0x (fused fingers), Q70.2x (fused toes), Q70.3x (webbed toes) with the appropriate digit/side character. Unspecified Q70.9 invites medical necessity scrutiny.

04How do I handle a cosmetic-exclusion denial from a commercial payer?

Appeal with documentation of functional impairment: gait analysis notes, shoe-fitting problems, digital contracture measurements, or dermatitis/infection in the web space. Purely aesthetic correction without functional findings will not survive most appeal processes.

05Does the 90-day global period apply to both facility and non-facility settings?

Yes. The 90-day global applies regardless of site of service. Post-op visits for the same condition within that window are bundled. Bill unrelated conditions with modifier 79 for procedures or modifier 24 for E/M visits — document why the encounter is unrelated to the syndactyly repair.

06Is prior authorization typically required for 28345?

Most commercial payers and Medicaid plans require prior authorization for elective reconstructive foot procedures. Confirm with the specific plan before scheduling — auth denials for 28345 often cite the cosmetic-vs-reconstructive distinction.

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 specific web space(s) released, presence and source of any skin graft, degree of syndactyly (simple vs. complex), and documented functional deficits (gait, shoe wear, contracture) directly from dictation. That prevents the two most common denials for 28345: cosmetic-exclusion rejections due to missing functional impairment language, and audit flags from operative notes that fail to identify distinct web spaces when multiple units are billed.

See how Mira captures CPT 28345 documentation