Surgical fusion of all four hindfoot and ankle joints — tibiotalar, subtalar, talonavicular, and calcaneocuboid — performed as a single procedure using internal fixation.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $1,106.57
- Total RVUs
- 33.13
- Global, days
- 90
- Region
- Foot & ankle
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 6 cited references ↓
- Explicit identification of all four joints fused: tibiotalar, subtalar, talonavicular, and calcaneocuboid
- Type and placement of internal fixation (screws, K-wires) at each joint level
- Preoperative diagnosis with supporting imaging confirming multi-joint pathology (arthritis, post-traumatic deformity, or fracture sequelae)
- Operative note confirming all joints were accessed and prepared for fusion — not just the primary joint
- Laterality (left or right foot) documented in both the operative note and on the claim
- Post-op weight-bearing restrictions and follow-up plan to support medical necessity of a 90-day global
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 ↓
CPT 28705 covers pantalar arthrodesis, the simultaneous fusion of the ankle (tibiotalar), subtalar, talonavicular, and calcaneocuboid joints. All four joints must be addressed in the same operative session for the code to apply. Fixation typically involves a combination of screws and K-wires; the operative note must identify each joint fused and the hardware used at each level.
This is one of the most technically demanding foot and ankle procedures in the CPT system, reflected in its 90-day global period. That global covers the pre-op day, the surgery itself, and all routine post-op management through day 90. Anything unrelated to the fusion billed within that window requires modifier 24 or 25.
Code selection turns on joint count. If the surgeon fuses only the subtalar joint, use 28725. If only talonavicular is fused, use 28730. If both talonavicular and calcaneocuboid are fused but the subtalar is not addressed, 28705 does not apply — drop down to the appropriate component code(s). Billing 28705 for a two- or three-joint fusion when a four-joint pantalar wasn't performed is a top audit flag for this code family.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 19.82 |
| Practice expense RVU | 10.2 |
| Malpractice RVU | 3.11 |
| Total RVU | 33.13 |
| Medicare national rate | $1,106.57 |
| Global period | 90 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 | $1,106.57 |
HOPD (APC 5116) Hospital outpatient department | $17,913.59 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $13,461.22 |
Common denial reasons
The recurring reasons claims for CPT 28705 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Joint count mismatch — operative note documents fewer than four joints fused, undercutting the pantalar descriptor
- Missing laterality modifier LT or RT, triggering claim edits at many payers
- Global period violations — post-op E/M or minor procedures billed without modifier 24 or 25 within the 90-day window
- Medical necessity not established — no supporting imaging or conservative treatment failure documented prior to surgery
- Upcoding flag when talonavicular and calcaneocuboid fusion is documented but subtalar and tibiotalar involvement is absent from the operative note
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What's the difference between 28705 and 28725?
02Can I bill 28705 if the surgeon fused talonavicular and calcaneocuboid but not the subtalar?
03Do I need modifier LT or RT on 28705?
04Can 28705 be billed bilaterally in the same session?
05What does the 90-day global period cover for 28705?
06Is modifier 22 appropriate for pantalar arthrodesis with significant additional complexity?
07Can a co-surgeon (modifier 62) be billed on 28705?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/files/document/04-chapter4-ncci-medicare-policy-manual-2026-final.pdf
- 03aapc.comhttps://www.aapc.com/codes/cpt-codes/28705
- 04aapc.comhttps://www.aapc.com/codes/cpt-codes-range/28705-28760/
- 05fastrvu.comhttps://fastrvu.com/cpt/28705
- 06cgsmedicare.comhttps://www.cgsmedicare.com/medicare_dynamic/j15/partb/ptpb/ptp.aspx
Mira AI Scribe
Mira's AI scribe captures each joint fused by name from the surgeon's dictation, the fixation method and hardware at each level, and explicit laterality — the three elements audit teams target first on pantalar claims. That prevents the most common denial: billing 28705 when the operative note only confirms two or three joints were addressed.
See how Mira captures CPT 28705 documentation