Surgical arthrodesis of the first metatarsophalangeal joint, fusing the great toe's MTP joint to eliminate motion and relieve pain.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $1,040.10
- Total RVUs
- 31.14
- 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 ↓
- Diagnosis supported by imaging (weight-bearing X-rays minimum) with documented arthritic grade or deformity severity
- Operative note naming the fixation construct used (e.g., crossing screws, dorsal plate, screw-and-plate combination)
- Documentation of bone surface preparation technique (e.g., cup-and-cone reamers, flat cuts with saw)
- Laterality clearly stated in both the operative note and post-op diagnosis (right vs. left great toe)
- If bone graft used: graft source (autograft vs. allograft), harvest site, and distinct graft-site work documented separately
- Conservative treatment history demonstrating failure of non-surgical management prior to authorization and surgery
- Post-op weight-bearing restrictions and fusion protocol included in the procedure note or associated orders
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 28750 covers open arthrodesis of the first metatarsophalangeal (MTP) joint — the joint between the first metatarsal and the proximal phalanx of the great toe. The procedure eliminates joint motion by preparing opposing bone surfaces and securing them with internal fixation (screws, plates, or a combination) until fusion occurs. Indications include end-stage hallux rigidus, severe hallux valgus with arthritic changes, failed prior MTP procedures, and inflammatory arthropathy. The 90-day global period covers all routine post-op visits, wound care, and hardware-related follow-up through day 90.
When implant removal (e.g., 20680) is required before the arthrodesis can be performed, bill only 28750 — the implant removal is integral to completing the fusion and cannot be billed separately. If autogenous bone graft harvest is separately performed, 20900 may be appended on the same claim with modifier 51, provided the graft site work is documented as distinct. Toe-level laterality modifiers (T1–T9) are required by NCCI policy; MUE values for toe procedures are set at one unit per toe modifier, so bilateral great toe fusions require modifier 50 for physician billing or LT/RT on separate lines for ASC billing.
Hallucal fusion is performed by both orthopedic surgeons and podiatrists — the PUF reflects roughly equal utilization between specialties. The 90-day global means any unrelated E/M or procedure in that window needs modifier 24 or 79, respectively, to avoid automatic bundling denials.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 8.53 |
| Practice expense RVU | 21.44 |
| Malpractice RVU | 1.17 |
| Total RVU | 31.14 |
| Medicare national rate | $1,040.10 |
| 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 | $1,040.10 |
HOPD (APC 5114) Hospital outpatient department | $7,413.38 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $5,187.12 |
Common denial reasons
The recurring reasons claims for CPT 28750 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing laterality modifier (T1 or T2) triggering NCCI MUE rejection at the claim line level
- Implant removal (20680) billed same-day without understanding it is integral to the fusion — payer bundles or denies the add-on
- Lack of documented conservative treatment failure, causing medical necessity denial on pre-auth or post-pay audit
- Unrelated post-op E/M visits billed without modifier 24, triggering automatic global period bundling
- Bone graft code (20900) appended without modifier 51 or without distinct documentation of separate graft-site work
- Operative note describes 'standard approach' without naming fixation hardware or bone prep technique, prompting audit downcoding
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01Which toe modifiers are required when billing 28750?
02Can 20680 (implant removal) be billed on the same day as 28750?
03Is bone graft separately billable with 28750?
04How do you handle a bilateral great toe fusion billed to Medicare?
05What is the global period for 28750 and what does it include?
06When is modifier 22 appropriate for 28750?
07Can 28750 be billed same-day with hallux valgus correction codes like 28296?
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
- 03tldsystems.comhttps://www.tldsystems.com/removal-implant-and-conversion-fusion
- 04aapc.comhttps://www.aapc.com/codes/cpt-codes/28750
- 05cgsmedicare.comhttps://www.cgsmedicare.com/medicare_dynamic/j15/partb/ptpb/ptp.aspx
Mira AI Scribe
Mira's AI scribe captures the fixation construct (screw configuration, plate type, or hybrid), bone preparation method, laterality, graft use and harvest site if applicable, and post-op weight-bearing protocol directly from the surgeon's dictation. That specificity prevents the two most common audit flags for 28750: operative notes that omit fixation detail and missing laterality documentation that triggers NCCI MUE rejections at claim submission.
See how Mira captures CPT 28750 documentation