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Billing code 28309: Metatarsal osteotomyMedicare rate & RVUs

Reports operative osteotomy of multiple metatarsals to correct forefoot alignment, length, or angulation when more than one metatarsal is treated.

CMS RVU26DEffective Oct 1, 2026109 payment localities892 Medicare services in 2024

Medicare pays $835.69 for 28309 nationally in a facility.

Medicare rate · 28309

Metatarsal osteotomy

Swap in your local Medicare rate.

Work RVUs
13.81
Total RVUs
25.02
Global days
090

National rate · 2026

$835.69

Facility setting, before claim adjustments.

See every locality for 28309 → · Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

On this page 10 sections
  1. Medicare rate
  2. What 28309 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 28309 covers

This procedure involves making planned bone cuts in multiple metatarsals to change forefoot alignment, length, or angulation. Podiatrists and orthopedic foot-and-ankle surgeons may use it to correct a multiray forefoot deformity or a metatarsal alignment pattern contributing to overload. It is generally performed in an operating room, often alongside other separately indicated forefoot procedures.

Select the code when the operative report supports osteotomy of multiple metatarsals; document the bones treated, side, deformity, and correction performed. A single-metatarsal procedure may fall under a different code in this family. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 28309 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

28309 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$765.67
Alaska*Unavailable$1,052.03
ArizonaUnavailable$815.59
ArkansasUnavailable$757.04
AtlantaUnavailable$856.97
AustinUnavailable$845.40
BakersfieldUnavailable$843.80
Baltimore/Surr. CntysUnavailable$882.73
BeaumontUnavailable$803.42
BrazoriaUnavailable$820.15

28309 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
28309 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 28309 rate is calculated

Each of 28309’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 28309

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 13.81Practice expense 8.96Malpractice 2.25

25.0200 adjusted RVUs×$33.4009 conversion factor=$835.69

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 28309

28309 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 28309

Metatarsal osteotomy

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.69/0.21Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 28309

Metatarsal osteotomy

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

28309 without 50 · national facility

$835.69

Metatarsal osteotomy

28309-50 · Bilateral: 150%

$1,253.54

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

28309 compared with similar codes

Compare codes

28309 vs 28306 vs 28307 vs 28308 vs 28322: national Medicare rates

Swap in your local Medicare rate.

  • 28309
    Metatarsal osteotomy · 13.81 wRVU
    —
  • 28306
    Metatarsal osteotomy · 5.85 wRVU
    $628.27
  • 28307
    Metatarsal osteotomy · 6.34 wRVU
    $844.71
  • 28308
    Metatarsal osteotomy · 5.34 wRVU
    $585.52
  • 28322
    Metatarsal repair · 8.32 wRVU
    $813.98

How to choose

28306Metatarsal osteotomy
This code is for an osteotomy of the first metatarsal. Choose 28309 when multiple metatarsals are osteotomized.
28307Metatarsal osteotomy
This code describes first-metatarsal osteotomy with autograft. 28309 is used for osteotomy of multiple metatarsals.
28308Metatarsal osteotomy
This code applies to an osteotomy of a metatarsal other than the first, per metatarsal; 28309 applies when multiple metatarsals are treated.
28322Metatarsal repair
This code addresses repair of a metatarsal nonunion or malunion. 28309 describes osteotomy to correct alignment, length, or angulation.

Codes related to 28309

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 28309
CodeHow it relatesNational office range
Same family
28306Metatarsal osteotomyMetatarsal osteotomy code for the first metatarsal.$557.81–$816.28
28307Metatarsal osteotomyFirst-metatarsal osteotomy code that includes autograft.$740.07–$1,107.22
28308Metatarsal osteotomyFor an osteotomy of a metatarsal other than the first, per metatarsal.$520.30–$764.52
Used instead
28322Metatarsal repairRepair code for metatarsal nonunion or malunion, rather than planned osteotomy correction.$723.34–$1,041.86

28309 billing questions

When should 28309 be chosen over 28308?

Use 28309 when multiple metatarsals are osteotomized. Code 28308 is for an osteotomy of a metatarsal other than the first, reported per metatarsal.

What should the operative note identify?

Document the metatarsals treated, laterality, the deformity or alignment problem, and the correction performed. The record should support that multiple metatarsals underwent osteotomy.

How is bilateral surgery reported?

When the procedure is performed bilaterally, report modifier 50; CMS pays it at 150%.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

Can an assistant surgeon be paid?

Assistant-at-surgery payment is allowed only when medical necessity is documented. CMS does not permit co-surgeons or team surgery for this code.

How does CMS handle other procedures in the same session?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 28309PPRRVU2026_Oct_nonQPP.csv, line 3,186 (RVU26D)

Open CMS sourceHow we calculate rates

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