Surgical fusion of a single midtarsal or tarsometatarsal (Lisfranc) joint using internal fixation to permanently immobilize that joint.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $848.38
- Total RVUs
- 25.4
- 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 5 cited references ↓
- Operative note must name the specific joint fused (e.g., first tarsometatarsal, talonavicular, calcaneocuboid) — 'midfoot fusion' alone is insufficient.
- Confirm single-joint scope explicitly; if more than one joint was addressed, 28730 applies and the note must support that instead.
- Document cartilage preparation technique and type of fixation hardware used (screws, plate, staples, etc.).
- Include pre-operative imaging (weight-bearing X-rays, CT if used) demonstrating joint pathology that supports the arthrodesis indication.
- Record failed conservative treatment (duration, modalities tried) to support medical necessity for elective fusions.
- ICD-10 diagnosis must match the specific joint and underlying pathology documented in the history and operative report.
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 5 cited references ↓
CPT 28740 covers open arthrodesis of one midtarsal or tarsometatarsal joint. Midtarsal joints include the talonavicular and calcaneocuboid articulations; tarsometatarsal joints (Lisfranc complex) involve the cuneiforms and cuboid articulating with the metatarsal bases. The procedure requires joint preparation—cartilage removal down to subchondral bone—followed by rigid fixation with screws, plates, or staples to achieve bony union across a single joint. This is a 90-day global procedure.
Code selection hinges on joint count. 28740 is strictly one joint. If you fuse multiple midtarsal or tarsometatarsal joints in a single session, 28730 applies instead. Confusing the two is one of the most common audit findings in foot arthrodesis billing. The operative note must identify the specific joint by name and confirm single-joint scope.
Common indications include post-traumatic arthritis following Lisfranc injury, primary osteoarthritis, flatfoot deformity correction at the medial column, and symptomatic midfoot instability failing conservative care. ICD-10 diagnosis codes should reflect the underlying pathology—arthritis, deformity, or injury sequela—and must align precisely with the joint documented in the operative report.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 9.06 |
| Practice expense RVU | 15.05 |
| Malpractice RVU | 1.29 |
| Total RVU | 25.4 |
| Medicare national rate | $848.38 |
| 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 | $848.38 |
HOPD (APC 5114) Hospital outpatient department | $7,413.38 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $5,216.09 |
Common denial reasons
The recurring reasons claims for CPT 28740 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Code billed as 28740 but operative note describes fusion of multiple joints — should be 28730; payers and auditors flag the mismatch on joint count.
- Medical necessity denial when pre-operative documentation lacks evidence of conservative treatment failure or supporting imaging.
- ICD-10 diagnosis code does not match the joint or laterality documented in the operative report, triggering CPT-ICD mismatch edits.
- Bone graft harvest (e.g., 20900) billed separately without modifier when payer considers it bundled — check NCCI edits; 28740 + 20900 is a complexity-adjusted pair under HOPD rules.
- Missing or vague operative note — 'standard midfoot fusion' without joint-level specificity is insufficient for audit defense and triggers downcoding or denial.
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01What is the difference between 28740 and 28730?
02Can I bill bone graft harvest separately with 28740?
03What modifier do I use if I fuse the same joint on a patient who returns with a complication during the 90-day global?
04Does the 90-day global period affect E/M billing for post-op visits?
05How should I code a bilateral midtarsal fusion performed in the same session?
06Which ICD-10 codes most commonly support 28740 for Medicare?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
Mira AI Scribe
Mira's AI scribe captures the specific joint name (e.g., first tarsometatarsal, talonavicular), fixation method, cartilage preparation technique, and laterality directly from surgeon dictation. It flags if multiple joints are mentioned — prompting review of whether 28730 is the correct code — before the claim is submitted. That prevents the most common audit finding on foot arthrodesis: a single-joint code attached to a multi-joint procedure note.
See how Mira captures CPT 28740 documentation