Closed reduction of a metatarsophalangeal joint dislocation performed under anesthesia, without surgical incision.

Verified May 8, 2026 · 6 sources ↓

Medicare: $174.69
Work RVU: 1.91
Global, days: 10
Region: Foot & ankle

Drawn from CMSAAPCNIHFindacodeGenhealth

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify which MTP joint was reduced (e.g., second MTP, great toe MTP) — 'toe dislocation' alone is insufficient for audit purposes.
Document the type and administration of anesthesia used; absence of anesthesia documentation supports 28630 instead of 28635.
Record pre- and post-reduction imaging (X-ray) confirming dislocation diagnosis and successful realignment.
Note the reduction technique and immobilization method applied after reduction (splint, buddy tape, etc.).
Document mechanism of injury and clinical findings that confirm dislocation versus fracture-dislocation.

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 25 Significant separate E/M 52 Reduced services 59 Distinct service 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 6 cited references ↓

CPT 28635 covers non-incisional realignment of a dislocated metatarsophalangeal (MTP) joint — where a metatarsal meets a toe phalanx — performed under anesthesia. The physician manually manipulates the toe back into anatomical position using closed reduction technique. No skin incision is made. Post-reduction immobilization (splint or buddy taping) is typically applied.

The anesthesia requirement is what distinguishes 28635 from 28630, which covers closed MTP dislocation treatment without anesthesia. If anesthesia is used and documented, 28635 is the correct code. If the dislocation requires open reduction, step up to 28645. The 10-day global period covers the manipulation and routine follow-up through day 10; separate E/M visits for unrelated complaints within that window need modifier 24.

This code sits in the fracture and dislocation procedures section for foot and toes. Podiatry accounts for the majority of reported utilization per CMS Physician Data Files. Orthopedic surgeons and emergency physicians also perform this procedure. Site of service matters: the HOPD facility rate differs substantially from the ASC rate — see the Site of Service comparison table.

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 (1.91) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (5.23) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.91
Practice expense RVU	3.1
Malpractice RVU	0.22
Total RVU	5.23
Medicare national rate	$174.69
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	$174.69
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 28635 get rejected.

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

Anesthesia not documented — payers downcode to 28630 (closed treatment without anesthesia).
Missing post-reduction X-ray report or imaging reference in the operative/procedure note.
Unbundling: billing 28635 with an E/M on the same date without modifier 25 on the E/M.
Incorrect toe or joint specified in diagnosis coding — ICD-10 laterality or toe-level mismatch triggers medical necessity edits.
Global period conflict — billing a related follow-up visit within the 10-day global without modifier 24.

Frequently asked questions

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

01What's the difference between 28630 and 28635?

28630 is closed MTP dislocation treatment without anesthesia. 28635 requires anesthesia. Document anesthesia clearly — that single element determines which code is correct, and payers will downcode to 28630 if it's missing.

02Can I bill 28635 for the great toe MTP joint?

Yes. The MTP joint series covers all five toes. Specify the toe in both the procedure note and the ICD-10 diagnosis code for laterality and digit level.

03What if closed reduction fails and I have to open the joint?

Step up to 28645 (open treatment of MTP dislocation). Do not bill 28635 and 28645 together for the same joint on the same date — that will trigger an NCCI bundling edit.

04How does the 10-day global period affect same-day E/M billing?

If you evaluate the patient and then perform the reduction at the same encounter, append modifier 25 to the E/M. Follow-up visits within the 10-day global for the same condition are bundled. Append modifier 24 only for unrelated E/M visits within the global window.

05Is modifier 50 appropriate if I reduce dislocations on bilateral feet in the same session?

Yes — modifier 50 applies when the same procedure is performed bilaterally in the same session. Some payers require LT/RT instead; verify payer-specific rules before submitting.

06Can 28635 be billed with fracture care codes if there's also a toe fracture?

A fracture-dislocation is a different clinical scenario. If you're treating both a fracture and a dislocation at the same joint, review whether a combination code or separate codes with modifier 59 (distinct procedural service) are appropriate, and document each injury and treatment distinctly.

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 MTP joint reduced, anesthesia type and administration note, reduction maneuver performed, post-reduction stability assessment, imaging findings cited, and immobilization applied. That documentation chain directly supports 28635 over the lower-paying 28630 and prevents downcoding denials at pre-payment audit.

See how Mira captures CPT 28635 documentation