Arthrodesis of the interphalangeal joint of the great toe — surgical fusion specifically at the IP joint of the hallux.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $918.19
- Total RVUs
- 27.49
- 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 ↓
- Confirm operative note specifies great toe (hallux) IP joint — not a lesser toe or MTP joint
- Document fixation method used (e.g., screw, K-wire, plate) and joint preparation technique
- If bone graft is used, document donor site and whether graft is separate from bone resected at the fusion site
- ICD-10 diagnosis code must support hallux pathology (e.g., hallux rigidus, IPJ arthritis, mallet deformity of great toe)
- For any E/M during the 90-day global, document why the visit is unrelated to the surgical procedure if billing with modifier 24
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 28755 covers arthrodesis of the interphalangeal (IP) joint of the great toe only. It does not apply to lesser toes — IP joint fusion of the 2nd through 5th toes goes to 28285. That distinction is a persistent miscoding trap: if the operative note says 'interphalangeal fusion' without specifying the great toe, auditors and payers will scrutinize the diagnosis codes to confirm hallux involvement.
The procedure carries a 90-day global period. All routine post-op office visits, hardware checks, and wound care through day 90 are bundled. An E/M visit during the global is billable only with modifier 24 if it addresses a problem unrelated to the fusion — for example, a visit about a screw migrating toward the skin surface that is causing a new clinical concern distinct from the routine surgical course. Document the unrelated condition explicitly.
Fixation method and bone graft use should be documented in the operative note. If bone graft is harvested from a separate donor site (not just local bone resected during the fusion itself), 20900 may be separately billable — but payer acceptance varies. Confirm coverage policy before appending it.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 7.31 |
| Practice expense RVU | 19.27 |
| Malpractice RVU | 0.91 |
| Total RVU | 27.49 |
| Medicare national rate | $918.19 |
| 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 | $918.19 |
HOPD (APC 5114) Hospital outpatient department | $7,413.38 |
ASC (PI A2) Ambulatory surgical center (freestanding) | $3,695.53 |
Common denial reasons
The recurring reasons claims for CPT 28755 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Wrong code used — 28755 billed for a lesser toe IPJ fusion that should be coded as 28285
- Missing or vague operative note that fails to identify the specific toe or joint fused
- E/M billed during the 90-day global period without modifier 24 and supporting documentation of an unrelated condition
- Bone graft add-on (20900) denied as bundled when payer considers it a component of the primary fusion
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01Can I use 28755 for a 2nd or 3rd toe IP joint fusion?
02What modifier do I append for an office visit during the 90-day global?
03Is bone graft separately billable with 28755?
04Does 28755 cover the MTP joint of the great toe as well?
05If hardware from a prior 28755 fusion needs removal, how is that billed?
06Can 28755 be billed bilaterally in the same session?
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 (hallux IP joint vs. MTP joint vs. lesser toe), fixation hardware used, bone graft source if applicable, and the pathology driving the fusion. That detail prevents the most common denial — 28755 rejected because the note didn't clearly distinguish the great toe IP joint from a lesser toe or a different great toe joint.
See how Mira captures CPT 28755 documentation