Surgical reconstruction of a congenital cleft foot deformity, closing the V-shaped midfoot cleft and restoring functional foot architecture.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,025.07
Total RVUs: 30.69
Global, days: 90
Region: Foot & ankle

Drawn from CMSFastrvuAAPCAacpmSciencedirect

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm congenital cleft foot diagnosis with ICD-10 code specific to the anomaly and laterality
Describe the V-shaped cleft anatomy encountered intraoperatively, including which rays are absent or malformed
Detail each surgical step: excision of the cleft, osseous realignment, soft-tissue closure technique, and any skin plasty or syndactylization performed
State whether synthetic or biologic graft material was used — if so, code separately; 28360 excludes graft application
Document laterality (left vs. right foot) to support LT/RT modifier assignment
Record estimated blood loss, tourniquet time, and any complications that would support modifier 22 for increased procedural complexity

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 58 Staged or related 62 Co-surgeons 73 Discontinued pre-anesthesia 74 Discontinued post-anesthesia 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 28360 covers open surgical reconstruction of a cleft foot — a congenital anomaly characterized by a V-shaped midline defect extending proximally toward the ankle, often with absent central rays. The procedure involves removing the cleft, realigning remaining osseous and soft-tissue structures, and may include skin plasty or syndactylization techniques to restore a functional, plantigrade foot. It does not include application of synthetic or biologic grafts; those require separate coding.

This is a high-complexity congenital foot reconstruction with a 90-day global period. All routine postoperative visits, wound care, and cast changes within 90 days are bundled. Separate E/M services in the global window require modifier 24. If a second procedure is performed at the same session — for example, polydactyly correction (28344) or desyndactyly reconstruction (28345) — append modifier 51 to the lower-valued code.

The procedure sits in the Repair, Revision, and/or Reconstruction range for the foot and toes (28200–28360). Given the congenital nature of the indication, ICD-10 specificity matters: payers will scrutinize diagnosis codes that don't clearly map to a documented congenital cleft foot anomaly. Operative notes that describe only 'midfoot reconstruction' without naming the cleft deformity and the specific surgical steps taken invite downcoding or denial.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	14.55
Practice expense RVU	13.05
Malpractice RVU	3.09
Total RVU	30.69
Medicare national rate	$1,025.07
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	$1,025.07
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,682.29

Common denial reasons

The recurring reasons claims for CPT 28360 get rejected.

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

Diagnosis code does not clearly map to a congenital cleft foot deformity — general midfoot or structural codes without congenital specificity trigger medical necessity denials
Operative note lacks procedural detail, describing only 'foot reconstruction' without documenting the cleft anatomy or specific corrective steps taken
Missing or incorrect laterality modifier (LT or RT) on the claim, causing rejection by payers that require it for unilateral foot procedures
Unbundling conflict when skin plasty or syndactylization steps are billed separately rather than included within 28360
Prior authorization not obtained — given the congenital nature and high RVU value, many commercial payers require PA for this procedure

Frequently asked questions

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

01Does 28360 include skin grafting or biologic graft application?

No. CPT 28360 excludes synthetic or biologic graft application. If a graft is placed, code it separately. Skin plasty and syndactylization techniques are included.

02Can 28360 be billed bilaterally on the same date?

Cleft foot is typically unilateral, but if bilateral reconstruction is performed, use modifier 50 and document both sides in the operative note. Some payers require separate line items with LT and RT instead.

03What ICD-10 code supports 28360?

Q72.7x (reduction defect of foot) and related congenital foot anomaly codes are the appropriate ICD-10 diagnoses. The code must reflect a documented congenital cleft foot — acquired midfoot deformities do not support 28360.

04Can 28360 be billed with 28344 (polydactyly) or 28345 (syndactyly) at the same session?

Yes. These are separately reportable when distinct procedures are performed. Append modifier 51 to the lower-valued code. Document each procedure discretely in the operative note.

05What does the 90-day global period cover for 28360?

All routine postoperative care from the day of surgery through day 90 is bundled, including office visits, wound care, cast changes, and suture removal. Unrelated E/M services need modifier 24; a staged or related procedure in the global period needs modifier 78.

06Is prior authorization typically required for 28360?

Most commercial payers require prior authorization given the high RVU and elective reconstructive nature. Confirm PA requirements before scheduling — denial for missing PA is not recoverable after the fact.

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 cleft anatomy description, absent or malformed rays, and each reconstructive step — closure technique, osseous realignment, and any syndactylization — directly from dictation. It flags if graft material is mentioned so the coder knows to add a separate line rather than bundle it into 28360. This prevents the most common audit flag: an operative note that says 'reconstruction performed' without documenting the specific congenital deformity or the surgical approach taken to correct it.

See how Mira captures CPT 28360 documentation