CPT Code 28760: Jones-Type Arthrodesis Billing Guide

Key Takeaways

CPT Code 28760 describes arthrodesis with extensor hallucis longus (EHL) transfer to the first metatarsal neck and fusion of the great toe interphalangeal joint, known as the Jones-type procedure.

Missing the laterality modifier (LT or RT) is the leading cause of claim denials for CPT 28760. Every claim must specify the operative foot.

The 2026 Medicare Physician Fee Schedule lists CPT 28760 with a work RVU of 8.91. Verify current rates using the CMS MPFS Look-Up Tool, since geographic modifiers affect final allowables.

Pabau’s claims management software links operative documentation directly to claim submission, reducing modifier errors and ICD-10 mismatches for podiatry and orthopedic billing teams.

CPT Code 28760 is a billable code for arthrodesis of the great toe interphalangeal (IP) joint combined with an extensor hallucis longus (EHL) tendon transfer to the first metatarsal neck, the Jones-type procedure. Payers auditing these claims routinely find operative reports that confirm the joint fusion but omit the tendon transfer, the defining element of the code. When the transfer isn’t documented, the claim downcodes or denies entirely. This guide covers the official descriptor, 2026 Medicare rates, RVU breakdown, applicable modifiers, ICD-10 pairings, and the documentation elements auditors look for.

CPT 28760 sits at the top of the arthrodesis range for the foot and toes (28705-28760). It combines two distinct surgical components: joint fusion and tendon transfer. Documentation that addresses only one component leads to denials. Podiatrists, orthopedic surgeons, and their billing staff need to understand both the clinical procedure and the payer requirements before submitting claims. Practices using claims management software that links operative notes to claim fields catch these errors before submission rather than after.

CPT Code 28760: Official description and procedure overview

The American Medical Association’s CPT code set assigns the following official descriptor to CPT Code 28760: Arthrodesis with extensor hallucis longus transfer to first metatarsal neck, great toe, interphalangeal joint (e.g., Jones-type procedure).

Three anatomical elements define this code. All three must be present in the operative report for the claim to stand up to audit.

• Arthrodesis of the great toe interphalangeal (IP) joint: the proximal and distal phalanges of the hallux are surgically fused, eliminating motion at the IP joint.
• Extensor hallucis longus (EHL) tendon transfer: the EHL tendon is released distally and re-routed, typically to the dorsal aspect of the first metatarsal neck, redirecting its pull.
• First metatarsal neck attachment: the transferred EHL is anchored to the first metatarsal neck, correcting the dynamic deformity causing toe clawing.

CPT 28760 is categorized under Musculoskeletal System: Foot and Toes – Arthrodesis in the CPT codebook. The full arthrodesis range for the foot runs from 28705 (arthrodesis, pantalar) through 28760. Coders selecting the wrong code in this range will undercode the claim. For example, 28755 (arthrodesis, great toe IP joint, includes any internal fixation) does not include the EHL tendon transfer component that 28760 requires.

The Jones-type procedure: Clinical context and indications

The Jones procedure was first described for claw toe deformity of the hallux caused by weakness in the intrinsic foot muscles. This weakness is most commonly seen in patients with Charcot-Marie-Tooth disease, poliomyelitis sequelae, or other neuromuscular conditions. Today, orthopedic and podiatric surgeons also perform Jones-type arthrodesis for hallux rigidus that has progressed to IP joint instability, and for fixed claw toe deformity unresponsive to conservative treatment.

Understanding the indications matters for coding because medical necessity documentation must match the ICD-10 diagnosis code submitted with the claim. A mismatch between the clinical indication in the operative note and the diagnosis code on the claim is a common denial trigger for CPT 28760.

Primary clinical indications

• Claw toe deformity of the great toe: dynamic deformity caused by EHL overactivity or intrinsic muscle weakness, creating hyperextension at the MTP joint and flexion at the IP joint.
• Hallux rigidus with IP joint involvement: end-stage arthritis of the great toe IP joint requiring fusion to restore function and eliminate pain.
• Neuromuscular foot deformity: Charcot-Marie-Tooth, polio, and cerebral palsy cases where tendon imbalance drives structural foot deformity.
• Failed conservative management: orthotics, physical therapy, and injections that have not resolved the deformity after an adequate treatment period.

Practices treating neuromuscular conditions alongside standard podiatry procedures may find that physical therapy and musculoskeletal care documentation tools help structure pre-operative conservative treatment records. These records are critical for establishing the failure-of-conservative-care requirement many payers enforce before approving surgical claims.

ICD-10 diagnosis codes that support CPT Code 28760

Medical necessity for CPT 28760 must be established by the diagnosis code(s) on the claim. The AAPC CPT-to-ICD-10 crosswalk identifies the most commonly accepted pairings. Local Coverage Determinations (LCDs) issued by Medicare Administrative Contractors (MACs) specify which ICD-10 codes they accept for foot arthrodesis procedures. Severe complications such as gangrene, reported under ICD-10 code I96, point toward a different surgical pathway rather than elective arthrodesis. Always verify against the applicable LCD for your MAC jurisdiction.

Always verify ICD-10 pairings against your MAC’s LCD. Medical necessity determinations are payer-specific and subject to annual updates. Diagnosis codes that one payer accepts may trigger a medical necessity review under another payer’s policy. Coders cross-checking musculoskeletal diagnosis codes such as M72.8 against payer LCDs benefit from a centralized coding workflow that flags non-compliant pairings before submission.

CPT Code 28760 reimbursement and 2026 fee schedule

Reimbursement for CPT Code 28760 under the Medicare Physician Fee Schedule varies by geographic locality because the GPCI (Geographic Practice Cost Index) adjusts the base national rate for each Medicare Administrative Contractor region. The figures below reflect 2026 national average rates. Always verify current allowables using the CMS Physician Fee Schedule Look-Up Tool, which provides locality-specific rates updated annually.

The non-facility rate is higher because practice expense RVUs reflect the overhead costs the surgeon’s office absorbs when the procedure is performed in an office-based setting rather than a hospital or ASC. For most Jones-type procedures, the facility setting (hospital or ASC) is standard due to the complexity of the arthrodesis and tendon transfer. Use the FastRVU 2026 RVU lookup tool to verify exact values for your practice location.

The 90-day global period means Medicare will not separately reimburse evaluation and management visits, routine post-operative dressing changes, or suture removal within 90 days of the procedure. Services unrelated to the procedure can still be billed during the global period with appropriate modifiers.

Applicable modifiers for CPT Code 28760

Modifier selection for CPT 28760 is where billing errors concentrate. Podiatry and orthopedic procedures are inherently unilateral and require laterality modifiers on every claim. Submitting without one is the single most common reason this code denies on first submission.

Modifier 50 (bilateral) requires particular care for CPT 28760. Bilateral Jones-type procedures in a single session are clinically uncommon, though bilateral neuromuscular deformity treated simultaneously does occur. Payers will likely request operative documentation before paying both sides. Never append modifier 50 speculatively. Only use it when the operative report explicitly confirms bilateral procedures performed in the same operative session. Modifier 59 draws similar scrutiny in other procedure families, such as pilonidal cyst excision billed under CPT codes 11770-11772, where payers expect clear documentation of a distinct anatomical site.

Documentation requirements for CPT Code 28760 reimbursement

The operative report for CPT 28760 must confirm all three procedure components to withstand audit. Practices using digital forms and structured clinical documentation can build procedure-specific operative note templates that prompt surgeons to capture each required element. If a wound healing complication requires a skin graft, such as one billed under CPT code 15101, report it separately from the original arthrodesis claim.

Auditors reviewing CPT 28760 claims look for these specific documentation elements:

• Preoperative diagnosis: clearly states the clinical indication (e.g., hallux rigidus with IP joint deformity, claw toe deformity secondary to Charcot-Marie-Tooth) matching the ICD-10 code on the claim.
• Procedure narrative confirming EHL transfer: explicitly describes the EHL tendon being released, mobilized, and re-routed to the first metatarsal neck – not just “tendon transfer” or “soft tissue procedure.”
• IP joint fusion confirmation: documents the joint preparation (cartilage removal, bony surfaces prepared), fixation method used (K-wire, screw, or staple), and the position of fusion (typically 5-10 degrees of plantar flexion).
• Laterality confirmed in operative note: the note must state “right foot” or “left foot” – matching the modifier on the claim.
• Intraoperative imaging reference: fluoroscopy or X-ray confirmation of fixation position, if used – supports medical necessity and documents the completed fusion.
• Post-operative plan: weight-bearing status, immobilization device, DVT prophylaxis documented per a DVT nursing care plan, and follow-up schedule. Required for global period management.

Operative documentation for CPT 28760 must be retained in line with state medical record retention laws and CMS requirements (commonly 7 years, longer for Medicare Advantage and Part D plans at 10 years), and stored in a HIPAA-compliant manner. Practices that maintain HIPAA-compliant documentation for medical offices can build retention schedules that meet both state and payer requirements without manual tracking.

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Common billing errors and denial reasons for CPT Code 28760

Denials for CPT 28760 cluster around a small number of recurring issues. Understanding each one helps billing staff correct claims faster and reduce the denial rate over time. Practices billing other complex surgical codes, such as CPT code 01634, tend to see similar patterns in claim rejections: systematic documentation failures rather than isolated coding mistakes.

Practices that bill CPT 28760 alongside other foot and ankle procedures, such as CPT code 11760, should audit their claim denial patterns quarterly. A 90-day denial pattern review often reveals systematic issues like a single coder consistently omitting laterality modifiers or a surgeon whose operative note template doesn’t capture the tendon transfer component.

Related CPT codes in the arthrodesis range (28705-28760)

Selecting the right arthrodesis code requires understanding the anatomical scope of each code in the 28705-28760 range. The following table helps coders distinguish CPT 28760 from adjacent codes. This distinction matters most when multiple arthrodesis procedures are performed in the same session on different joints of the same foot. Practices that also supply post-operative mobility aids, such as a rigid walker billed under HCPCS code E0130, should code the device separately from the surgical fee.

The critical distinction is between 28755 and 28760. Both involve arthrodesis of the great toe IP joint. Only 28760 includes the EHL tendon transfer to the first metatarsal neck. If the surgeon performed only the IP joint fusion without the tendon transfer, 28755 is the correct code. Upcoding to 28760 without a documented EHL transfer in the operative report is a billing error with audit risk. Practices providing sports medicine and orthopedic care see this distinction frequently when reviewing intraoperative reports.

How Pabau supports podiatry and orthopedic billing workflows

Billing for surgical CPT codes like 28760 requires consistent documentation that connects the operative note to the claim fields. A missing modifier, an undocumented procedure component, or the wrong ICD-10 code anywhere in that chain costs the practice revenue and triggers rework. Pabau’s claims management software connects clinical documentation to claim submission in one workflow, so podiatry and orthopedic billing teams can validate documentation completeness before claims are submitted rather than after they deny.

Practices handling structured medical forms and documentation workflows benefit from templates built around specific CPT codes: pre-operatively capturing the conservative care history that payers require, intraoperatively prompting surgeons to document both the EHL transfer and the IP joint fusion, and post-operatively tracking the 90-day global period to prevent billing conflicts. Pabau’s platform also supports the practice management workflows that high-volume surgical practices need: multi-provider scheduling, team-based documentation, and integrated billing review.

Conclusion

CPT Code 28760 denials are almost always preventable. The code has a clear two-component requirement: IP joint arthrodesis plus EHL tendon transfer. Every denial pattern traces back to one of those components being absent from the operative report, the ICD-10 selection, or the modifier. Fix the documentation template, and the denials stop.

Pabau’s claims management tools give podiatry and orthopedic practices a structured path from operative documentation to clean claim submission, catching modifier omissions and ICD-10 mismatches at the source. To see how Pabau handles surgical billing workflows for foot and ankle procedures, book a demo.

Continue your research

Billing another distinct-site procedure in the same session? Pilonidal cyst excision under CPT codes 11770-11772 follows the same modifier 59 distinct-procedure documentation standard.

Coding a post-operative wound complication? A skin graft billed under CPT code 15101 needs its own documentation, separate from the original arthrodesis claim.

Ruling out a severe vascular complication? Gangrene reported under ICD-10 code I96 points to a different surgical pathway than elective arthrodesis.

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