CPT code 28740 – Single midtarsal or tarsometatarsal joint fusion

Key takeaways

CPT code 28740 reports fusion of one midtarsal or tarsometatarsal joint, such as an isolated talonavicular, calcaneocuboid or single Lisfranc joint fusion.

Fusing two or more of these joints, or the whole transverse tarsal joint, is reported with 28730. Code 28735 adds an osteotomy to that fusion.

Great toe fusions are not 28740: the first MTP joint is 28750 and the great toe interphalangeal joint is 28755.

The 2026 Medicare file gives 28740 a 90-day global period, 9.06 work RVUs and 17.29 total facility RVUs.

Medicare applies the 150% bilateral payment rule and standard multiple-procedure reductions, and an assistant at surgery may be paid.

What is CPT code 28740?

CPT code 28740 is the procedure code for arthrodesis, midtarsal or tarsometatarsal, single joint, in the American Medical Association’s CPT code set. It reports surgical fusion of one joint in the midfoot, where the tarsal bones meet each other or the metatarsal bases.

The code sits in the Surgery section, under the Musculoskeletal System subsection for the foot and toes (28001-28899). Within that range, it belongs to the arthrodesis family that runs from 28705 to 28760.

The surgeon exposes the joint, removes the remaining cartilage from both surfaces and brings the prepared bone ends together. Screws, plates or staples then hold the joint while it fuses into one solid segment.

Which joints does CPT 28740 cover?

CPT 28740 covers a single joint in one of two midfoot regions. The descriptor names them both, so the joint’s location and the joint count decide whether the code fits.

• Midtarsal (Chopart) region: the talonavicular joint, between the talus and the navicular, and the calcaneocuboid joint, between the calcaneus and the cuboid.
• Tarsometatarsal (Lisfranc) region: the joints where the five metatarsal bases meet the three cuneiforms and the cuboid.

The coding rule follows from the word “single.” An isolated talonavicular fusion, or a fusion of the first tarsometatarsal joint alone, fits 28740. Once the operative note lists two or more of these joints, the descriptor for 28730 is the closer match. The chart below adds the two other exits that catch miscoded fusions: an added osteotomy and a great toe joint.

Clinical indications for CPT 28740

Surgeons bill CPT 28740 when one midfoot joint is painful, unstable or deformed and conservative care has not helped. The diagnosis on the claim has to explain why that one joint needed fusing.

• Primary osteoarthritis: degenerative arthritis isolated to one midfoot joint, often the first tarsometatarsal or the talonavicular joint.
• Post-traumatic arthritis: joint damage after a Lisfranc injury, a navicular fracture or an old midfoot sprain.
• Tarsometatarsal instability: a persistent Lisfranc subluxation or dislocation where the surgeon chooses primary fusion.
• Charcot neuroarthropathy: neuropathic joint collapse limited to one midfoot joint, often in patients with diabetes.
• Inflammatory arthritis: rheumatoid or other inflammatory joint destruction confined to a single midfoot joint.

Payers expect the record to show the conservative care tried before surgery. That usually means orthotics or bracing, activity changes, medication and injections, with the dates and the response to each.

ICD-10-CM codes commonly paired with CPT 28740

Every 28740 claim needs an ICD-10-CM code that supports fusing that joint. Most foot codes carry laterality, so match the right or left foot to the operative note.

Injury codes take a seventh character for the encounter. A fusion done months after a Lisfranc injury may call for the sequela character S on the injury code rather than A, the initial-encounter character. For example, S93.324S would go on the claim with an M19.x arthritis code as the other diagnosis. Check the ICD-10-CM update each October 1 before you rely on a pairing.

CPT 28740 vs neighboring arthrodesis codes

Most coding errors on 28740 come from three questions: how many joints, which region and whether an osteotomy was added. The table sets 28740 against the codes it is most often confused with.

A first MTP fusion for hallux rigidus is never 28740, however close the code numbers look. Our guide to CPT code 28750 covers that fusion’s descriptor, payment and documentation.

2026 Medicare payment and RVUs for CPT 28740

Medicare pays CPT 28740 from the relative value units in the CMS Physician Fee Schedule relative value files. The figures below come from the 2026 October release, before any geographic adjustment.

The $33.4009 conversion factor applies to clinicians who are not qualifying APM participants. Qualifying participants use $33.5675, which lifts the national facility amount to about $580.38.

Midfoot fusions are done in a hospital or surgical center, so the facility column applies to the surgeon’s fee. Use the CMS Physician Fee Schedule lookup tool to see your locality’s rate after the GPCI adjustment.

Coding 28740 when the note supports 28730 underpays the case, and the reverse overpays it. Both are compliance problems, so the code has to match the joint count in the record.

Modifiers, global period and bilateral rules for CPT 28740

CPT 28740 carries a 090 global period. The global covers the day before surgery, the day of surgery and 90 days after it, including routine postoperative visits.

The 2026 Medicare file sets four payment indicators that shape how you bill the code:

• Multiple procedures (indicator 2): standard reductions apply, with the highest-valued procedure at 100% and the next ones at 50%.
• Bilateral surgery (indicator 1): Medicare pays 150% of the single-procedure amount when the same fusion is done on both feet.
• Assistant at surgery (indicator 2): an assistant may be paid without extra documentation of medical necessity.
• Co-surgeons (indicator 1): co-surgeon payment needs documentation that two surgeons were medically necessary.

Toe modifiers (TA and T1 to T9) describe toes, so they do not identify a midfoot joint. For split care, the 2026 file divides 28740 into 10% preoperative, 69% intraoperative and 21% postoperative work.

CPT 28740 is subject to the National Correct Coding Initiative edits, which CMS updates every quarter. Check the current procedure-to-procedure table before adding a second code from the same session. Add 59 or XS only when the record proves a separate procedure.

Does CPT 28740 need prior authorization?

Original Medicare does not require prior authorization for CPT 28740 at the time of writing. Medicare Advantage and commercial plans often do, and their rules vary by plan.

A complete prior authorization request for 28740 usually includes:

• The diagnosis with its ICD-10-CM code and the affected side
• Dates and results of the conservative treatment already tried
• Weight-bearing X-rays, or CT or MRI where used, showing the joint involved
• Pain and function scores that show how the joint limits the patient
• The planned joint, approach and fixation method

Documentation requirements for CPT 28740

The operative report has to show a fusion of one named joint. A note that says only “midfoot fusion” leaves the coder unable to choose between 28740 and 28730.

1. Joint named: the exact joint fused, such as “first tarsometatarsal joint” or “talonavicular joint.”
2. Joint count: a clear statement that one joint was fused, with no other midfoot joint prepared.
3. Joint preparation: cartilage removal and preparation of both joint surfaces, which separates fusion from debridement.
4. Fixation: the type, size and number of screws, plates or staples used.
5. Bone graft: the graft source and harvest site, if a graft was used.
6. Laterality: “right” or “left” foot, stated in the procedure note.
7. Additional procedures: any other procedure in the session, described separately with its own indication.

A clean claim for 28740 starts with these elements. Checking them before submission prevents most of the denials in the next section.

Top reasons CPT 28740 claims are denied and how to fix them

Most 28740 denials trace back to the joint count, the joint location or the paperwork. Matching each denial to its cause shows whether to correct the claim or appeal it. Our denial management guide covers the wider workflow.

Remittance advice codes tell you which row applies. Our list of denial codes in medical billing explains the reason codes that come back on a rejected 28740 claim.

How Pabau reduces denials on CPT 28740 claims

Midfoot fusion claims fail on small details, such as a joint count, a side or a missing signature. Many practices catch these by hand, after the payer has already rejected the claim.

Pabau, the practice management platform we build for specialty practices, moves those checks before submission. Its denial-reducing claims software turns the invoice into an electronic CMS-1500 claim. Through the Claim.MD clearinghouse integration, it checks eligibility in real time before surgery day.

Claim statuses update from the payer, and electronic remittance advice posts back against the invoice. Your billing team sees which 28740 claims were paid, which were denied and why, without a second spreadsheet.

Get midfoot fusion claims paid first time

Pabau checks eligibility, sends electronic claims through Claim.MD and tracks every 28740 denial by reason. Your team fixes the cause before the next claim goes out.

Book a demo

Conclusion

CPT 28740 rewards precise operative notes. When the note names one midfoot joint, the side and the fixation, the code choice is simple and the claim holds up in an audit.

The risk sits at the edges of the code. A second prepared joint moves the case to 28730, and a great toe fusion belongs to 28750 or 28755. Build those two checks into coding review before claims leave the practice.

Book a demo to see how Pabau helps your billing team catch coding and eligibility errors before a 28740 claim reaches the payer.

Continue your research

Need a reference for clearinghouse claims submission end to end? Claim.MD clearinghouse overview explains how electronic claim routing and ERA posting work for surgical practices.

Want the full path from encounter to payment? Revenue cycle management fundamentals covers each step from scheduling to final payment for procedure-heavy practices.

New to billing surgical codes like 28740? What is medical billing explains how claims, codes and payer rules fit together.

Frequently asked questions