CPT code 28113 – Fifth metatarsal head ostectomy

Key takeaways

CPT 28113 reports complete excision of the fifth metatarsal head, the bone just behind the little toe.

Report it once per foot, because each foot has one fifth metatarsal and the Medicare MUE is one unit per date of service.

The first to fourth metatarsal heads have their own codes, 28111 and 28112, and a partial bunionette excision reports as 28110.

The CY2026 work RVU is 5.96 and the global period is 90 days, so routine post-op visits are not billed separately.

NCCI bundles 28110 and 28288 into 28113 on the same foot, while 28113 itself bundles into 28114 and 28122.

CPT code 28113: Official descriptor and what it covers

CPT code 28113 is the code for ostectomy, complete excision; fifth metatarsal head, as published in the American Medical Association’s CPT code set. The surgeon removes the whole head of the fifth metatarsal, leaving the shaft behind it. The code applies to the fifth metatarsal only, and it is reported once per foot.

The word “complete” is what separates 28113 from CPT 28110, which removes only the bunionette prominence on the outer side of the head. The other metatarsal heads have their own codes. The first head reports as 28111, and the second, third or fourth head reports as 28112.

Key code facts

Clinical indications for complete fifth head excision

Surgeons remove the whole fifth metatarsal head when a smaller procedure would not relieve the pain or clear the disease. These are the indications most often documented with 28113:

• Bunionette (tailor’s bunion): A painful, arthritic or recurrent bunionette where shaving the lateral prominence alone would not be enough.
• Intractable plantar keratosis under the fifth head: A callus that keeps returning beneath the fifth metatarsal head despite debridement, padding and orthoses.
• Fifth-ray deformity: A plantarflexed or prominent fifth metatarsal, or a dislocated fifth metatarsophalangeal (MTP) joint, overloading the outer forefoot.
• Joint destruction or infection: Arthritis or chronic osteomyelitis confined to the fifth metatarsal head, often beneath a plantar ulcer in a patient with diabetes.

The code does not include a tendon transfer, an implant or work on another ray. Each of those carries its own code, subject to the NCCI edits below.

How the procedure is performed: Clinical context for accurate coding

A coder who knows the surgical steps can match the operative note to the descriptor more reliably. A fifth metatarsal head ostectomy usually follows this sequence:

1. Incision: A dorsal or dorsolateral incision over the fifth MTP joint, protecting the nearby cutaneous nerve.
2. Joint exposure: A capsulotomy exposes the fifth metatarsal head.
3. Excision: The surgeon cuts across the metatarsal neck and removes the whole head. The note should state the level of the cut.
4. Stump finishing: The cut end of the shaft is smoothed so it does not create a new pressure point.
5. Closure: The wound is irrigated, the capsule is repaired where possible and the skin is closed in layers.

What auditors look for: The report must name the fifth metatarsal and confirm that the whole head was removed. A note that describes shaving the lateral eminence supports 28110, not 28113. A bone cut that repositions the metatarsal and keeps the head is an osteotomy, which reports as 28308.

CPT 28113 vs related metatarsal codes: How to tell them apart

The 281xx and 282xx foot codes split by which bone is treated and how much of it is removed. The NCCI column below comes from the Medicare practitioner procedure-to-procedure (PTP) table effective October 1, 2026.

Units, laterality and bilateral billing

Report 28113 once per foot. Each foot has a single fifth metatarsal, so the code is never multiplied by the number of heads removed. The Medicare MUE for 28113 is 1 unit per date of service, with a policy-based adjudication indicator.

When both fifth metatarsal heads come out in one session, Medicare expects one line with modifier 50 and 1 unit. The CY2026 bilateral surgery indicator is 1, so the bilateral line pays 150% of the single-side amount. Some commercial payers want two lines with RT and LT instead, so check each payer’s rules.

If another procedure is done in the same session, multiple procedure indicator 2 applies. The highest-valued procedure pays in full and each additional one pays at 50%. An assistant at surgery is payable only when documentation shows medical necessity.

NCCI edits and bundling rules

The CMS National Correct Coding Initiative (NCCI) PTP table lists code pairs. The column 2 code in each pair is not paid separately when billed with the column 1 code on the same day. These pairs involving 28113 appear in the October 2026 practitioner table:

• 28110 and 28288 bundle into 28113. A partial excision or condylectomy of the same head is part of removing the whole head.
• 28113 bundles into 28114 and 28122. A Clayton-type resection already includes the fifth head, and 28122 is the column 1 code against 28113.
• Phalangeal work bundles too. Partial excision of a toe phalanx (28124) and resection of a phalangeal base (28126) are column 2 to 28113.
• No edit with 28111, 28112, 28285 or 28308. These codes treat a different bone, so they are not blocked by a PTP pair.

Each of these pairs carries modifier indicator 1. A modifier such as XS or 59 bypasses the edit only when the second procedure was on a separate structure. The other foot is the usual example. Never use one to unbundle work on the same metatarsal.

NCCI tables change every quarter, so confirm a pair in the current file before you appeal a bundling denial.

ICD-10-CM codes that support medical necessity

Payers check medical necessity by matching the procedure to a supporting diagnosis. These ICD-10-CM codes fit the usual indications for fifth metatarsal head excision:

Confirm every code against the current fiscal-year ICD-10-CM release. FY 2027 codes took effect on October 1, 2026.

CPT code 28113 reimbursement: CY2026 RVUs and Medicare payment

The figures below come from the CMS CY2026 Physician Fee Schedule RVU file (October 2026 release). They are national and unadjusted. Your local rate also depends on the Geographic Practice Cost Index, so check it in the CMS Physician Fee Schedule Look-Up Tool.

CY2026 has two conversion factors. Clinicians who qualify for the Advanced APM incentive (QP) use $33.5675, and everyone else uses $33.4009. Commercial rates are set by each contract, so compare them against your own fee schedule.

The 90-day global period

The global package covers the day before surgery, the operative day and 90 post-operative days. CMS splits the payment into 10% pre-operative, 69% intra-operative and 21% post-operative care. Routine wound checks, suture removal and standard follow-up visits in that window are not billed separately.

These services can be billed during the global period with the right modifier:

Prior authorization requirements

Prior authorization rules for fifth metatarsal head excision vary by payer and plan year. Check each payer’s provider portal before you schedule the case. These patterns hold broadly:

• Traditional Medicare: No prior authorization program applies to 28113, but Medicare Advantage plans often require one.
• Medicaid: Many state programs and their managed care plans require prior authorization for elective foot surgery.
• Commercial insurers: Most ask for weight-bearing X-rays, a record of failed conservative care and a statement of functional limits.

Documentation that supports the claim

On audit, a 28113 claim stands or falls on the operative report and the pre-operative chart. Together they should cover these points:

• The bone treated: The note must name the fifth metatarsal head. A note that names another metatarsal supports 28111 or 28112 instead.
• Extent of excision: Confirm that the whole head was removed and state the level of the cut through the neck.
• Clinical indication: Record the complaint, how long it has lasted and how it limits walking or footwear.
• Conservative care: List prior treatments, such as padding, orthoses, wider shoes, injections or debridement, with dates.
• Imaging: Include weight-bearing foot X-rays that show the fifth-ray pathology.
• Laterality: State right or left in both the pre-operative assessment and the operative note.
• Other procedures: Describe any procedure on another ray or toe with its own detail and indication.

Strong medical billing compliance means the whole record, from the first visit to the post-op notes, supports the decision to operate.

Common denial reasons and how to prevent them

Claims for CPT code 28113 fail for a predictable set of reasons. Understanding the denial codes in medical billing you receive helps you fix each one quickly.

A clean claim on the first pass is the fastest route to payment for foot surgery codes.

How claims management software supports foot surgery billing

Foot surgery billing often runs across several tools. The operative note sits in one system, the claim is keyed into another and remittances arrive by mail or a separate portal. Each handoff is a chance to send the wrong units or lose track of a denial.

Pabau, the practice management and EHR platform we build, keeps the consultation notes, consent forms and operative records in the patient file. Your billing team enters the codes and modifiers, then sends the claim through the Claim.MD clearinghouse. Pabau’s claims management software then tracks each claim’s status.

Electronic remittance advice (835 files) comes back into Pabau, so payments and denials post against the claim they belong to. Your team can see which 28113 claims are paid, pending or denied without chasing paper.

Track every foot surgery claim to payment

Pabau sends claims through Claim.MD, tracks their status and posts 835 remittances against them. Your team spends less time chasing 28113 payments and denials.

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Conclusion

CPT 28113 is a narrow code, and that narrowness protects the claim. It covers the whole fifth metatarsal head, on one foot, once. When the note names the fifth metatarsal and describes a complete excision, the code choice is settled.

Two habits cause the avoidable denials. One is billing 28113 per head instead of per foot, and the other is adding a bundled partial excision on the same foot. Drop both, and use modifiers 24, 58, 78 or 79 for work inside the 90-day window. Book a demo to see how Pabau tracks foot surgery claims from submission to remittance.

Continue your research

Need to contest a downcoded or bundled claim? Medical appeal form template gives you a structured form for disputing a denied claim.

Want to understand how 835 remittance files work? Electronic remittance advice explained covers the 835 transaction set and how to match payments to claims.

Looking for a structured approach to reducing write-offs? Revenue cycle management fundamentals walks through the billing workflow from eligibility check to payment posting.

Frequently asked questions