Closed reduction of a metatarsophalangeal joint dislocation performed without anesthesia, using manual manipulation to restore normal joint alignment.

Verified May 8, 2026 · 5 sources ↓

Medicare: $171.68
Work RVU: 1.71
Global, days: 10
Region: Foot & ankle

Drawn from CMSAAPCGenhealthMdclarityAAOS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Identify the specific MTP joint treated (first through fifth toe)
Document mechanism of injury and acute presentation (pain, swelling, deformity)
Confirm closed treatment — no incision made, joint manipulated externally
Explicitly state no anesthesia was used to support 28630 vs. 28635 code selection
Pre- and post-reduction radiographic findings confirming dislocation and reduction
Post-reduction neurovascular status of the affected digit

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 25 Significant separate E/M 50 Bilateral procedure 52 Reduced services 58 Staged or related 76 Repeat, same physician 77 Repeat, another 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 28630 covers closed treatment of a metatarsophalangeal (MTP) joint dislocation performed without anesthesia. The provider manually manipulates the dislocated toe back into anatomic alignment — no incision, no sedation. This is the least invasive entry point in the MTP dislocation code family, which steps up through 28630 (no anesthesia), 28635 (with anesthesia), and 28645 (open treatment).

The 010 global period means one follow-up day is included. Post-reduction imaging, splinting instructions, and the reduction itself are all bundled. If you see the patient beyond that window for a complication or unrelated issue, append the appropriate modifier to break out of the global. The procedure is predominantly performed by podiatry, though orthopedic foot-and-ankle surgeons bill it as well.

Document which MTP joint was involved (first through fifth), the mechanism, the pre- and post-reduction clinical and radiographic findings, and the fact that no anesthesia was used. Missing any of these creates an audit exposure — particularly the anesthesia distinction, since 28635 pays differently and requires its own documentation rationale.

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 (1.71) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (5.14) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.71
Practice expense RVU	3.14
Malpractice RVU	0.29
Total RVU	5.14
Medicare national rate	$171.68
Global period	10 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	$171.68
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI P3) Ambulatory surgical center (freestanding)	$105.74

Common denial reasons

The recurring reasons claims for CPT 28630 get rejected.

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

Anesthesia use documented in the note but 28630 (without anesthesia) billed — should be 28635
Missing post-reduction imaging to confirm the dislocation diagnosis and successful reduction
Same-day E/M billed without modifier 25 when a separate, significant evaluation occurred
ICD-10 diagnosis code doesn't specify laterality or is a fracture code rather than a dislocation code
Bilateral same-session treatment billed without modifier 50 or individual LT/RT modifiers

Frequently asked questions

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

01What's the difference between 28630, 28635, and 28645?

28630 is closed reduction without anesthesia. 28635 is closed reduction with anesthesia. 28645 is open treatment requiring an incision. Bill 28630 only when you document that no anesthesia — local, regional, or general — was used.

02Can I bill a separate E/M on the same day as 28630?

Yes, but only if the E/M was a significant, separately identifiable service beyond the decision to reduce the dislocation. Append modifier 25 to the E/M code and document the distinct medical decision-making.

03What global period applies to 28630?

010 — one post-op day is included. Routine follow-up the next day is bundled. Any visit after day 1 is separately billable without a modifier.

04If I treat multiple MTP joints in the same session, how do I bill?

Bill 28630 for the primary joint. Use modifier 59 or append an additional unit for each additional MTP joint treated, depending on payer policy. Document each joint individually in the procedure note.

05The dislocation recurs and I reduce it again during the 010 global — what modifier applies?

If you're the same provider performing the same procedure on the same joint within the global period, append modifier 76 (repeat procedure by same physician). If a different provider performs the repeat reduction, use modifier 77.

06Should I append LT or RT to 28630?

Yes. Most payers require laterality modifiers for foot procedures. Append LT or RT to indicate which foot. If both feet are treated in the same session, use modifier 50 or bill separate lines with LT and RT.

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 MTP joint involved, mechanism, pre- and post-reduction exam findings, explicit confirmation that no anesthesia was administered, and post-reduction imaging results directly from dictation. This prevents the most common audit flag for 28630: operative or procedure notes that omit the anesthesia status, forcing a coder to guess between 28630 and 28635.

See how Mira captures CPT 28630 documentation