Closed reduction of a toe interphalangeal joint dislocation performed with anesthesia.

Verified May 8, 2026 · 6 sources ↓

Medicare: $154.98
Work RVU: 1.92
Global, days: 10
Region: Foot & ankle

Drawn from CMSAAPCEmedny

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 toe and which interphalangeal joint (proximal or distal IP) was dislocated and reduced
Document that anesthesia was used and identify the type (local, regional, or general)
Record the mechanism of injury and pre-reduction clinical findings including neurovascular status
Note the reduction method and confirm post-reduction alignment, ideally with imaging
If multiple toe joints were treated, document each joint separately with distinct clinical justification

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

28665 covers closed treatment of a dislocated interphalangeal (IP) joint of a toe — meaning no incision — when anesthesia is required to achieve reduction. The interphalangeal joints connect the phalanges within each toe; all toes except the hallux have two such joints (proximal and distal IP). When reduction can be accomplished without anesthesia, report 28660 instead. The anesthesia requirement is the distinguishing factor between these two codes, and missing that distinction is a common audit flag.

The global period is 10 days. That window covers the procedure, immediate post-op care, and routine follow-up through day 10. Any E/M visit within those 10 days for a problem unrelated to the dislocation needs modifier 24. If you're billing an E/M on the same day as the procedure for a separately identifiable reason, append modifier 25 to the E/M.

NCCI policy restricts reporting multiple closed dislocation treatment codes for the same anatomic area at the same encounter. If multiple IP joint dislocations in the same toe region are treated at one session without casting, only one code is billable for that anatomic area. If treatment of one dislocation required manipulation and another did not, only the code for treatment with manipulation is reportable. Document each joint treated and the clinical rationale if billing multiple toes from different anatomic areas.

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 (1.92) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (4.64) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.92
Practice expense RVU	2.53
Malpractice RVU	0.19
Total RVU	4.64
Medicare national rate	$154.98
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	$154.98
HOPD (APC 5102) Hospital outpatient department	$285.75
ASC (PI A2) Ambulatory surgical center (freestanding)	$153.62

Common denial reasons

The recurring reasons claims for CPT 28665 get rejected.

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

Code billed without anesthesia documentation — payers may downcode to 28660 (without anesthesia)
Multiple units reported for the same anatomic area at one encounter, violating NCCI single-code-per-area bundling rules
E/M billed same-day without modifier 25, causing the office visit to deny as bundled into the global
ICD-10 diagnosis code does not specify laterality or the correct joint level, triggering a specificity denial
Missing imaging or objective confirmation of dislocation, leading to medical necessity denial on audit

Frequently asked questions

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

01What's the difference between 28660 and 28665?

Anesthesia. 28660 is closed IP joint dislocation treatment without anesthesia; 28665 requires anesthesia for reduction. If your note doesn't document anesthesia use, payers will downcode to 28660.

02Can you bill 28665 for multiple toes at the same encounter?

Only if the dislocations are in different anatomic areas. NCCI policy limits reporting to one closed dislocation treatment code per anatomic area treated at a single session. For truly separate toes, append modifier 59 or XS and document each joint distinctly. Bilateral same-toe procedures require modifiers LT and RT or 50.

03What is the global period for 28665?

10 days. Routine post-op care through day 10 is included. Unrelated E/M visits during that window need modifier 24; same-day separately identifiable E/M visits need modifier 25 on the E/M.

04Is radiologic guidance separately billable with 28665?

Only if it's distinctly documented and not integral to the reduction itself. Per NCCI policy, fluoroscopy used as a direct component of the procedure is not separately reportable. If imaging is performed independently to confirm reduction, document its separate purpose clearly.

05Which diagnosis codes pair with 28665?

Use ICD-10 codes from the S93.1xx range for dislocation of interphalangeal joint of toe. Specify laterality (right vs. left foot) and the affected toe. Non-specific or unspecified joint codes are a common trigger for medical necessity denials.

06If the dislocation recurs and needs repeat reduction, which modifier applies?

Modifier 76 if the same provider repeats the procedure for the same condition. Modifier 78 applies if the patient returns to the OR during the global period for a related complication. Use 79 only for a truly unrelated procedure during the global.

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 (proximal vs. distal IP), anesthesia type, reduction technique, and post-reduction neurovascular and alignment findings from dictation. That detail prevents the two most common denials: downcoding to 28660 for missing anesthesia documentation, and medical necessity rejections from audit teams that flag operative notes lacking pre- and post-reduction clinical findings.

See how Mira captures CPT 28665 documentation