Percutaneous skeletal fixation of a toe interphalangeal joint dislocation, performed with manipulation to reduce the joint and stabilize it using pins or screws inserted through the skin.
Verified May 8, 2026 · 4 sources ↓
- Medicare
- $164.00
- Work RVU
- 2.59
- Global, days
- 10
- Region
- Foot & ankle
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 4 cited references ↓
- Identify the specific toe and interphalangeal joint level (proximal IP vs. distal IP) treated
- Confirm the dislocation diagnosis with pre-reduction imaging and document the mechanism of injury
- Describe the manipulation technique used to achieve reduction and confirm post-reduction alignment
- Document percutaneous fixation method — type, number, and placement of pins or screws inserted through the skin
- Record post-procedure fluoroscopic or radiographic confirmation of joint reduction and hardware position
- If multiple joints treated in the same session, document each joint separately to support multiple units billed
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 4 cited references ↓
28666 covers percutaneous skeletal fixation of a dislocated toe interphalangeal (IP) joint — meaning the provider reduces the dislocation through manipulation and then drives pins or screws through the skin to hold the joint in alignment without opening the surgical site. This is the operative step up from closed treatment under anesthesia (28665) and a step below open treatment (28675). The interphalangeal joints are the articulations between phalanges; each lesser toe has two IP joints (proximal and distal), while the hallux has one. Specify which joint and which toe in documentation.
The global period is 010 — ten post-operative days of routine follow-up are included in the payment. Hardware checks, suture or pin-site wound care, and position confirmations within that window are not separately billable unless a distinct, unrelated problem is addressed. If the pin is removed as a planned secondary procedure after the global period, use a separate visit code; if it requires a return to the OR during the global for a related reason, append modifier 78.
The MUE for 28666 is 4 units (PRA adjudication), reflecting that a patient could have up to four IP joint dislocations treated in a single session across multiple toes. If you're billing multiple units, each must be supported by distinct documentation identifying the specific joint reduced and fixed.
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 (2.59) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (4.91) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 2.59 |
| Practice expense RVU | 2.11 |
| Malpractice RVU | 0.21 |
| Total RVU | 4.91 |
| Medicare national rate | $164.00 |
| 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 | $164.00 |
HOPD (APC 5113) Hospital outpatient department | $3,342.87 |
ASC (PI A2) Ambulatory surgical center (freestanding) | $1,644.87 |
Common denial reasons
The recurring reasons claims for CPT 28666 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Upcoding flags when documentation doesn't distinguish percutaneous fixation from closed treatment — missing reference to hardware placed through the skin
- MUE exceeded without per-joint documentation when billing more than one unit for multiple toe IP dislocations
- Global period violations when post-op pin-site checks or routine wound care are billed separately within the 10-day window without modifier 24 or 79
- Laterality ambiguity — claim denied or pended when the operative note and claim don't both specify left or right foot
- Diagnosis-procedure mismatch when the ICD-10 code reflects a fracture-dislocation but documentation supports only dislocation, or vice versa
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 4 cited references ↓
01What's the difference between 28665 and 28666?
02Can I bill 28666 for multiple toes in the same session?
03Do I need modifier LT or RT on this code?
04What is the global period for 28666?
05When is modifier 78 appropriate after a 28666 procedure?
06Is imaging bundled into 28666?
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 or distal IP), laterality, manipulation technique, and percutaneous hardware type from your dictation. That prevents the most common denial for 28666 — notes that document a reduction but omit confirmation that fixation was placed percutaneously, triggering downcodes to 28665.
See how Mira captures CPT 28666 documentation