Arthrodesis of the interphalangeal joint of the great toe with extensor hallucis longus tendon transfer to the first metatarsal neck.

Verified May 8, 2026 · 6 sources ↓

Medicare: $783.92
Total RVUs: 23.47
Global, days: 90
Region: Foot & ankle

Drawn from CMSPodiatrymAAPCAAOS

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 6 cited references ↓

Specify the joint fused: interphalangeal joint of the great toe (not MTP, not lesser toe).
Document the tendon transfer by name — extensor hallucis longus to first metatarsal neck — and describe the technique used.
Record type and size of fixation hardware implanted (screws, staples, plate) and confirm fixation was confirmed intraoperatively.
State the primary diagnosis driving the procedure (e.g., hallux rigidus, claw toe deformity, neuromuscular dysfunction) with corresponding ICD-10 code.
Include pre-op imaging findings (X-ray or CT) demonstrating joint pathology justifying arthrodesis over joint-sparing options.
Describe wound closure method and any bone graft used — autograft, allograft, or synthetic — if applicable.
Note laterality explicitly in both the operative note header and the procedure description to support LT/RT modifier assignment.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 28760 describes surgical fusion of the great toe interphalangeal joint combined with transfer of the extensor hallucis longus tendon to the first metatarsal neck. The arthrodesis permanently stabilizes the joint by preparing opposing bone surfaces and securing them with internal fixation hardware — typically screws, staples, or a plate — until osseous union occurs. The tendon transfer component realigns the extensor mechanism to offload the fusion site and correct associated deformity, most commonly a claw or mallet toe configuration secondary to hallux rigidus or neuromuscular imbalance.

This code sits within the arthrodesis section of foot and toe procedures (28705–28760). It is distinct from simpler great toe fusion codes (e.g., 28750, which covers first MTP joint arthrodesis) and from lesser-toe fusion codes (28285). The tendon transfer element is integral to 28760 — don't separately report extensor tendon repair or transfer codes for the same operative field.

The 90-day global period covers all routine post-op care through day 90, including cast changes, hardware checks, and wound management. Unrelated E/M services in that window require modifier 24. A staged revision or hardware removal for a complication returns to the global and requires modifier 78 if related, 79 if unrelated.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	8.91
Practice expense RVU	13.51
Malpractice RVU	1.05
Total RVU	23.47
Medicare national rate	$783.92
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	$783.92
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,705.52

Common denial reasons

The recurring reasons claims for CPT 28760 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Missing tendon transfer documentation — payers audit whether the EHL transfer was actually performed, since it distinguishes 28760 from simpler great toe fusion codes.
Wrong toe or joint billed — 28760 is exclusively the great toe IP joint; using it for lesser-toe IP fusions (correct code: 28285) triggers automatic downcoding.
Separate billing of extensor tendon repair/transfer in the same operative field — NCCI bundles tendon work integral to the fusion; use modifier 59/XS only if a truly distinct tendon procedure was performed on a separate structure.
Laterality modifier absent — MUE enforcement for toe procedures expects TA (great toe, left) or T5 (great toe, right) digit modifiers; claims without them may be rejected or suspended pending review.
Insufficient medical necessity documentation — failure to show failed conservative care or imaging-confirmed joint destruction before proceeding to fusion.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What separates 28760 from 28750?

28750 covers first MTP joint arthrodesis alone. 28760 is IP joint arthrodesis of the great toe with EHL tendon transfer to the first metatarsal neck. Different joint, different tendon component — these are not interchangeable.

02Do I need a digit modifier (TA/T5) in addition to LT/RT?

Yes. CMS NCCI policy directs that toe procedures use TA–T9 modifiers to identify the specific toe. The MUE for 28760 is set at one unit per toe, so digit modifiers are the mechanism that allows billing the same procedure on both feet in a staged setting. Omitting them is a common claim suspension trigger.

03Can I bill 28760 and a bunionectomy code together?

Only if they are distinct procedures at distinct anatomical sites. NCCI edits bundle 28288, 28306, 28307, 28310, and 28315 with bunionectomy codes (28291–28299) on the ipsilateral first toe or metatarsal. Review the NCCI PTP table before unbundling with modifier 59 or XS.

04How should hardware removal after 28760 be billed within the 90-day global?

Planned removal staged at the time of the original procedure: use modifier 58. Unplanned return for a complication related to the fusion (e.g., painful hardware, wound dehiscence): use modifier 78. Unrelated procedure during the global: modifier 79.

05Is fluoroscopy separately billable during this procedure?

Generally no. Intraoperative fluoroscopy used to confirm fixation alignment is considered part of the surgical package. Only bill imaging separately if a distinct diagnostic imaging service for a separate structure was performed and meets NCCI guidelines for separate reporting.

06What ICD-10 codes typically support medical necessity for 28760?

Common supporting diagnoses include M20.20 (hallux rigidus, unspecified foot), M20.21/M20.22 (hallux rigidus, specific foot), and deformity codes in the M20 range. Neuromuscular etiologies may use G57.60 (Morton's neuroma) or relevant paralytic deformity codes. Document failed conservative management before proceeding to arthrodesis.

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 fusion technique (bone surface preparation, fixation hardware type and size), the EHL tendon transfer to the first metatarsal neck, intraoperative fluoroscopic confirmation of alignment, and explicit laterality from dictation. This prevents the two most common audit flags: an operative note that documents arthrodesis but omits the tendon transfer (triggering downcoding to 28750) and a claim without a digit modifier that stalls in MUE review.

See how Mira captures CPT 28760 documentation