Closed reduction of a toe interphalangeal joint dislocation performed without anesthesia.

Verified May 8, 2026 · 6 sources ↓

Medicare: $149.30
Work RVU: 1.25
Global, days: 10
Region: Foot & ankle

Drawn from CMSFindacodeNIHEmednyAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify the specific toe and joint reduced (e.g., second toe PIP joint, left foot)
Confirm procedure performed without anesthesia — required to distinguish 28660 from 28665
Document pre- and post-reduction clinical exam findings, including neurovascular status
Record imaging (X-ray) confirming dislocation and, ideally, post-reduction alignment
Note any splint, buddy tape, or strapping applied and whether treating provider assumes follow-up care
Document mechanism of injury and relevant ICD-10 diagnosis code linking to the specific joint and laterality

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

LT Left side RT Right side 76 Repeat, same physician 77 Repeat, another physician 79 Unrelated during global 25 Significant separate E/M 59 Distinct service

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 28660 covers closed reduction of a dislocated interphalangeal (IP) joint of any toe — performed without anesthesia. The interphalangeal joints sit between adjacent phalanges; each lesser toe has a proximal IP (PIP) and distal IP (DIP) joint, while the great toe has a single IP joint. Reduction is accomplished by manual manipulation to restore joint alignment without any incision or sedation.

The 010-day global period covers the reduction and routine follow-up through the tenth post-procedure day. Casting, splinting, or strapping applied at the same encounter by the treating provider is bundled into 28660 per NCCI policy — don't report a separate strapping code if you're assuming follow-up care. If the same encounter involves multiple dislocations stabilized by a single cast or splint, only one dislocation treatment code is reportable for that anatomic area.

When anesthesia is required for reduction, report 28665 instead. If reduction fails and open treatment becomes necessary, that shifts to a different code family entirely. Document the specific joint reduced (PIP vs. DIP, which toe, which foot) and confirm no manipulation was performed under anesthesia — those distinctions drive code selection and support medical necessity.

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 (1.25) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (4.47) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.25
Practice expense RVU	2.97
Malpractice RVU	0.25
Total RVU	4.47
Medicare national rate	$149.30
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	$149.30
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI P3) Ambulatory surgical center (freestanding)	$99.70

Common denial reasons

The recurring reasons claims for CPT 28660 get rejected.

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

Anesthesia not addressed in documentation — payer downcodes or denies when it's unclear whether anesthesia was used, conflating 28660 with 28665
Separate strapping code billed same-day when provider assumes follow-up care — bundled under NCCI policy
Missing laterality or specific joint identification, triggering medical necessity or coding accuracy denials
Diagnosis code mismatch — ICD-10 must specify the correct toe and laterality to align with 28660

Frequently asked questions

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

01What's the difference between 28660 and 28665?

Anesthesia. Use 28660 when reduction is performed without anesthesia; use 28665 when anesthesia is required. Document explicitly which applies — payers audit this distinction.

02Can I bill a strapping code on the same day as 28660?

Not if you're assuming follow-up care. Per NCCI policy, casting, splinting, and strapping are bundled into the dislocation treatment code when the same provider handles post-op care. You can bill a strapping code separately only if you're providing the initial immobilization without assuming follow-up.

03Can I bill 28660 for multiple dislocated toes treated at the same visit?

Only if they required separate casts, splints, or straps — or if at least one required manipulation and another did not. NCCI limits you to one dislocation treatment code per anatomic area treatable by a single immobilization device. When multiple joints share a single splint, one code is reportable.

04What global period applies to 28660?

010-day global. Routine follow-up visits within those 10 days are included. An E/M billed during the global for an unrelated problem requires modifier 24.

05Which ICD-10 codes pair with 28660?

Use S93.11x–S93.13x range for IP joint dislocations of the foot, specifying toe and laterality. Confirm the diagnosis laterality matches the modifier (LT or RT) on the claim.

06Is 28660 payable in an ASC setting?

Yes. CMS assigns separate ASC payment to 28660. The ASC rate is substantially lower than the HOPD rate — see the Site of Service comparison table on this page.

07Should I use modifier 59 when billing 28660 alongside an E/M on the same date?

Use modifier 25 on the E/M, not 59, when a significant, separately identifiable evaluation precedes the reduction on the same day. Modifier 59 applies to procedure-to-procedure bundling edits, not E/M unbundling.

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 toe, joint level (PIP vs. DIP), laterality, and explicit confirmation that the reduction was performed without anesthesia — the key differentiator between 28660 and 28665. It also flags when strapping or splinting is applied so your coder knows not to bill a separate strapping code if follow-up care is assumed. This prevents the most common downcoding and bundling denials on IP joint reductions.

See how Mira captures CPT 28660 documentation