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28296 Cor hlx vlgs dstl mtar osteo

What 28296 is

CMS fee schedule short descriptor: Cor hlx vlgs dstl mtar osteo.

Full CPT long descriptions are licensed by the American Medical Association and are not published on this site; the short descriptor above is the one CMS prints in its own fee schedule file. See About CPT.

Medicare payment for 28296 (CY2026)

Work RVUPractice expense RVUMalpractice RVUTotalMedicare rate
Non-facility (office)8.0417.590.8226.45$883.45
Facility (hospital, ASC)8.045.640.8214.50$484.31

National rates: total RVUs x the CY2026 conversion factor of 33.4009 (non-QP), before geographic adjustment. Actual Medicare payment is 80% of the rate shown after the deductible; the patient or secondary payer owes the 20% coinsurance.


Status: Active - payable under the Physician Fee Schedule. Global period: 90-day global period.

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Medically Unlikely Edit (MUE)

Medicare caps 28296 at 1 unit per date of service for practitioner claims (MAI 2 - date of service edit (absolute): units above the MUE never pay), rationale: CMS Policy. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.

Billed with 28296? These codes are bundled into it

28296 is a Column 1 code in 296 active NCCI PTP edits. When one of these Column 2 codes is reported on the same date of service, it is denied as bundled - unless the edit's modifier indicator is 1 and documentation supports a distinct service with an NCCI-associated modifier.

Column 2 codeShort descriptionModifier indicator
01470Anes px nrv msc lw l/a/f nos0 - no modifier bypassCheck pair
0213TNjx paravert w/us cer/thor0 - no modifier bypassCheck pair
0216TNjx paravert w/us lumb/sac0 - no modifier bypassCheck pair
0490TRegn cell tx scldr h mlt inj1 - modifier may bypassCheck pair
0594TOsteot hum xtrnl lngth dev1 - modifier may bypassCheck pair
0596TTemp fml iu vlv-pmp 1st insj1 - modifier may bypassCheck pair
0597TTemp fml iu valve-pmp rplcmt1 - modifier may bypassCheck pair
0708TId ca immntx prep & 1st njx1 - modifier may bypassCheck pair
0709TId ca immntx each addl njx1 - modifier may bypassCheck pair
0718TAdrc ther prtl rc tear njx1 - modifier may bypassCheck pair
0903TEcg alg 12 lead reduced i&r1 - modifier may bypassCheck pair
0904TEcg alg 12 ld rdcd trcg only1 - modifier may bypassCheck pair
0905TEcg alg 12 ld rdcd i&r only1 - modifier may bypassCheck pair
11000Dbrdmt ecz/infected skin<10%1 - modifier may bypassCheck pair
11001Dbrdmt ecz/infct skn ea addl1 - modifier may bypassCheck pair
11004Dbrdmt skin xtrnl gent&per1 - modifier may bypassCheck pair
11005Dbrdmt skin abdominal wall1 - modifier may bypassCheck pair
11006Dbrdmt skin xtrnl gent per1 - modifier may bypassCheck pair
11042Dbrdmt subq tis 1st 20sqcm/<1 - modifier may bypassCheck pair
11043Dbrdmt musc&/fsca 1st 20/<1 - modifier may bypassCheck pair
11044Dbrdmt bone 1st 20 sq cm/<1 - modifier may bypassCheck pair
11045Dbrdmt subq tiss each addl1 - modifier may bypassCheck pair
11046Dbrdmt musc&/fsca ea addl1 - modifier may bypassCheck pair
11047Dbrdmt bone each addl1 - modifier may bypassCheck pair
11420Exc h-f-nk-sp b9+marg 0.5/<1 - modifier may bypassCheck pair
11421Exc h-f-nk-sp b9+marg 0.6-11 - modifier may bypassCheck pair
11422Exc h-f-nk-sp b9+marg 1.1-21 - modifier may bypassCheck pair
11423Exc h-f-nk-sp b9+marg 2.1-31 - modifier may bypassCheck pair
11424Exc h-f-nk-sp b9+marg 3.1-41 - modifier may bypassCheck pair
11730Avulsion nail plate simple 11 - modifier may bypassCheck pair

Showing 30 of 296 column 2 codes. Use the pair checker for any specific combination.

28296 is bundled into these codes

28296 appears as a Column 2 code in 6 active edits. Reported with one of these Column 1 codes on the same date of service, 28296 is the code that denies.

Column 1 codeShort descriptionModifier indicator
11010Debride skin at fx site1Check pair
11011Debride skin musc at fx site1Check pair
11012Deb skin bone at fx site1Check pair
28295Cor hlx vlgs prx mtar osteot1Check pair
28297Cor hlx vlgs jt arthrd1Check pair
28299Cor hlx vlgs double osteot1Check pair

Data: CMS CY2026 Physician Fee Schedule RVU file (October release, RVU26D) and Medicare NCCI PTP practitioner edits v32.3 (2026 Q4). Verify against the official files before billing or contracting decisions.