Hallux Valgus Correction
CPT codes hallux valgus correction by technique. The operative report determines the code, and choosing a code by habit rather than by the procedure performed is a common error.
- 28292: with resection of the proximal phalanx base, when performed, any method
- 28295: with proximal metatarsal osteotomy, any method
- 28296: with distal metatarsal osteotomy, any method
- 28297: first metatarsal and medial cuneiform joint arthrodesis, any method
- 28298: with proximal phalanx osteotomy, any method
- 28299: with double osteotomy, any method
Hammertoe And Lesser Toe Procedures
Hammertoe correction is reported with 28285, per toe, and 28286 is used for cock-up fifth toe with plastic skin closure. Lesser toe procedures on multiple toes are reported per toe with modifiers that identify each digit (T1 to T9 and TA).
Global Periods And Multiple Procedures
Most forefoot procedures carry a 90-day global period, which includes routine post-operative visits. When several procedures are performed in one session, Medicare applies the multiple procedure payment reduction, paying the highest-valued procedure in full and reducing the others. Correct sequencing and toe modifiers are needed for the claim to price correctly.
Prior Authorization And Medical Necessity
Many commercial and Medicare Advantage plans require prior authorization for bunion and hammertoe surgery and documentation of failed conservative care, pain and functional limitation, and imaging. Requesting authorization with complete documentation avoids post-surgery denials.
Frequently Asked Questions
- Is hardware removal billed separately?
- Hardware removal during the global period for a complication or as a staged procedure may be separately billable with the appropriate modifier. Routine removal as part of the original plan should be documented as staged.
Billing Support For This Specialty
Physicians Professional Billing Services, Inc. has billed wound care, surgical and procedural specialties since 1998, across every Medicare Part B MAC jurisdiction.
Primary Sources
This page is general information about billing and coverage rules and is not legal, coding or reimbursement advice for a specific claim. Coverage policies change; confirm current requirements with CMS and the applicable Medicare Administrative Contractor.