High-energy extracorporeal shock wave therapy (ESWT) delivered to the plantar fascia under ultrasound guidance, performed with regional or general anesthesia.

Verified May 8, 2026 · 7 sources ↓

Medicare: $303.95
Total RVUs: 9.1
Global, days: 90
Region: Foot & ankle

Drawn from CMSBcbsmsAAPCCgsmedicareMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Diagnosis of chronic plantar fasciitis with specific duration — most payers require failure of conservative care for at least 3–6 months
Documentation of prior failed conservative treatments (physical therapy, orthotics, corticosteroid injections, stretching programs)
Anesthesia type used (regional or general) and clinical justification for anesthesia beyond local
Ultrasound guidance report confirming targeting of the plantar fascia insertion site
Energy level delivered (joules/mm²), number of shocks, and frequency settings used during the session
Laterality (left or right foot) clearly stated in the operative note and on the claim

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 52 Reduced services 58 Staged or related 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 28890 covers high-energy ESWT directed at the plantar fascia for chronic plantar fasciitis that has failed conservative treatment. The procedure requires anesthesia beyond local (regional or general) due to the intensity of the energy delivered — that anesthesia requirement is built into the code descriptor and distinguishes 28890 from low-energy ESWT alternatives. Ultrasound guidance is also included in the code; billing a separate ultrasound guidance code alongside 28890 is incorrect per NCCI policy on procedures that already bundle imaging.

The code carries a 90-day global period. Any E&M visit for a reason unrelated to plantar fasciitis during that window requires modifier 24. A significant, separately identifiable E&M on the day of the procedure — beyond the decision to perform it — requires modifier 25. The HOPD and ASC payment rates differ substantially (see the Site of Service comparison table), making site-of-service selection a meaningful revenue variable. Several commercial payers, including BCBS affiliates, continue to classify ESWT for plantar fasciitis as investigational, so prior authorization and medical necessity documentation are critical before scheduling.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	3.36
Practice expense RVU	5.45
Malpractice RVU	0.29
Total RVU	9.1
Medicare national rate	$303.95
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	$303.95
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI P3) Ambulatory surgical center (freestanding)	$182.94

Common denial reasons

The recurring reasons claims for CPT 28890 get rejected.

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

Payer deems ESWT for plantar fasciitis investigational or non-covered — common with BCBS affiliates and some regional plans
Insufficient documentation of failed conservative care prior to ESWT, triggering medical necessity denial
Billing a separate ultrasound guidance code alongside 28890 — imaging is bundled into the descriptor and denied via NCCI
Missing or incorrect laterality modifier (LT/RT) causing claim rejection or downcoding
Prior authorization not obtained before the procedure, resulting in administrative denial regardless of medical necessity

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Is ultrasound guidance billable separately when performing 28890?

No. Ultrasound guidance is explicitly included in the 28890 descriptor. Billing a separate imaging code alongside it violates NCCI bundling rules and will be denied.

02Which modifier do I use if I perform ESWT on both feet in the same session?

Bill 28890 twice — one unit with modifier LT and one with modifier RT. Modifier 50 (bilateral) may be accepted by some payers but confirm payer-specific preference, as podiatry bilateral policies vary.

03Does Medicare cover 28890?

28890 is a covered Medicare code. However, medical necessity criteria apply — document chronic plantar fasciitis with failed conservative care. Some MAC jurisdictions have Local Coverage Determinations with specific minimum conservative care duration requirements; check your MAC's LCD before billing.

04How does the 90-day global period affect follow-up billing?

All routine post-procedure visits related to the plantar fasciitis are bundled through day 90. Use modifier 24 for unrelated E&M visits during the global and modifier 79 for a completely unrelated procedure performed during the global period.

05What is the difference between 28890 and 0101T for ESWT?

28890 is specific to plantar fascia, high energy, with anesthesia beyond local, and includes ultrasound guidance. Code 0101T covers extracorporeal shock wave to the musculoskeletal system not otherwise specified — use it only when the site or parameters fall outside the 28890 descriptor. Many payers treat 0101T as investigational.

06Can I bill an E&M on the same day as 28890?

Only if it is a significant and separately identifiable service unrelated to the decision to perform the ESWT. Append modifier 25 to the E&M. The decision to proceed with the procedure itself is not separately billable.

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 anesthesia type, energy settings (joules/mm², shock count, frequency), ultrasound guidance confirmation, laterality, and the treating diagnosis with duration of symptoms from the physician's dictation. It also flags documentation of prior failed conservative treatments. This prevents the two most common denial patterns: medical necessity rejections for inadequate conservative care history, and NCCI-triggered denials from separately billed ultrasound guidance that is already bundled into 28890.

See how Mira captures CPT 28890 documentation