Request Demo

Podiatry CPT Codes Billing Guide: CPT 11721, 20610, 28810 & More

According to the National Health Center Financial and Operational Performance Analysis (2020–2023), rural FQHCs delivered 3 million telehealth visits in 2023, but billing these services has only gotten more complex. Medicare’s non-behavioral telehealth flexibility expired September 30, 2025, and Medicaid policies vary significantly across all 50 states. Most billing teams struggle with which codes to use and what payment rates to expect.

Request Callback

A podiatry practice submits a claim for routine nail debridement. The documentation looks solid, the diagnosis codes are correct, but the claim comes back denied. The issue? A missing Q-modifier that should have been there all along. This scenario plays out in practice every day, and it’s getting worse. Medicare has ramped up enforcement around Q-modifiers, while commercial payers are bundling procedures tightly than ever.

The difference between a clean claim and a denial often comes down to knowing which code applies when. This guide breaks down the most frequently used podiatry CPT codes, from routine nail debridement (11721) to joint injections (20610) and surgical procedures like toe amputations (28810, 28820). Each code includes its proper application, required modifiers, and documentation requirements so your claims get paid right the first time.

Common Podiatry CPT Codes

The following are the most commonly used CPT codes for podiatry:

CPT Code 11721: Nail Debridement (6+ Nails)

Debridement of six or more nails, including trimming, shaping, and filing. Use CPT 11720 for one to five nails.

Code Details Requirements
Global Period 0 days
Frequency Limit Once per 60 days (Medicare)
Required Modifiers Q7, Q8, or Q9 (routine foot care) + LT/RT
Common Diagnoses E11.621, E11.40, E11.51

Key Billing Points:

  • Medicare requires Q-modifiers when billing as routine foot care
  • Must link to qualifying systemic condition
  • Document Class A, B, or C findings to support medical necessity

CPT Code 11730: Nail Avulsion (Removal)

Temporary nail plate removal, partial or complete, without matrix destruction.

Code Details Requirements
Global Period 0 days
Frequency Limit Same finger <4 months; same toe <8 months
Required Modifiers Digit modifiers (FA, F1–F9, TA, T1–T9)
Common Diagnoses L60.0 (ingrown nail)
NCCI Edit Cannot bundle with 11750 on same nail

Struggling with Medicare FQHC telehealth billing changes?

Get Expert Help

CPT Code 11750: Nail Removal with Matrix Destruction

Permanent nail removal, including chemical or surgical matrixectomy.

Code Details Requirements
Global Period 10 days
Required Modifiers KX (for repeat procedures on same toe)
Common Diagnoses L60.0 (chronic ingrown nail)
NCCI Edit Cannot bundle with 11730 on same nail

Key Billing Points:

  • Use modifier -59 or XS if performed on different nails during same session
  • Document failed conservative treatments

CPT Code 20610: Joint Injection

Arthrocentesis, aspiration, and/or injection of the major joint (ankle) without imaging guidance. Use CPT 20611 with ultrasound guidance.

Code Details Requirements
Global Period 0 days
Required Modifiers -25 (when E/M same day) + LT/RT
Common Diagnoses M25.571 (ankle pain), M19.071 (ankle arthritis)

Key Billing Points:

  • Document joint injected, substance administered (with NDC codes), and volume
  • Injection supplies included; cannot bill separately

CPT Code 28285: Hammertoe Correction

Correction through interphalangeal fusion, phalangectomy, and/or arthroplasty. Includes K-wire fixation, tenotomy, and capsulotomy at IP joints.

Code Details Requirements
Global Period 90 days
MUE Limit 4 units per session
Required Modifiers -51 (multiple procedures)
Common Diagnoses M20.41 (right), M20.42 (left)

Key Billing Points:

  • K-wire fixation included; do not bill separately
  • Covers hammer, claw, and mallet toe deformities
  • Cannot separately bill tenotomy or capsulotomy on same toe

CPT Code 28296: Bunion Surgery with Distal Osteotomy

Hallux valgus correction with bunionectomy and distal metatarsal osteotomy (Chevron, Austin procedures).

Code Details Requirements
Global Period 90 days
Required Modifiers LT/RT
Common Diagnoses M21.611 (right), M21.612 (left)
2024 Update Must include actual bunionectomy (medial eminence removal)

Key Billing Points:

  • Internal fixation and hardware insertion included
  • Document bunion angle measurements and clinical deformity
  • Related codes: 28295 (proximal), 28297 (Lapidus), 28298 (Akin), 28299 (double)

CPT Code 28810: Toe Amputation with Metatarsal

Single metatarsal amputation with toe (ray resection).

Code Details Requirements
Global Period 90 days
Required Modifiers T1–T5 (digit), -50 (bilateral)
Common Diagnoses E11.621 + L97.4-, M86.671–672 (osteomyelitis)
NCCI Edit Cannot bill with 28820 on same toe

Important Note:

Document vascular status and failed conservative treatment

CPT Code 28820: Toe Amputation at MTP Joint

Toe amputation at the metatarsophalangeal joint.

Code Details Requirements
Global Period 0 days (changed from 90 days in 2021)
Required Modifiers TA, T1–T9 (digit) + LT/RT
Common Diagnoses E11.621, L97.511–524

Key Billing Points:

  • Follow-up visits separately billable if medically necessary
  • Document wound care needs for follow-up justification
  • Different from 28810 (includes metatarsal) and 28825 (at IP joint)

CPT Code 11042: Wound Debridement (Subcutaneous)

Debridement of subcutaneous tissue (includes epidermis and dermis), first 20 square centimeters.

Code Details Requirements
Global Period 0 days
Add-on Code 11045 (each additional 20 sq cm)
Common Diagnoses L97.4- or L97.5- (diabetic foot ulcers)
Cannot Combine 11043, 11044 (same wound), 97597–97602

Key Billing Points:

  • Report deepest tissue level removed only
  • Calculate total area when debriding multiple wounds at same depth
  • Document wound measurements (length × width), depth, and tissue removed

CPT Code 99213: Established Patient Office Visit

Office visit for established patient requiring low to moderate medical decision-making or 20-29 minutes total time.

Code Details Requirements
Patient Status Seen within past 3 years
Time Range 20–29 minutes total time
MDM Level Low to moderate
Required Modifiers -25 (when billed with procedure same day)

Key Billing Points:

  • Code selection based on either MDM complexity or total time (since 2021)
  • Time includes face-to-face and non-face-to-face activities on date of service
  • Cannot bill for routine wound care included in another procedure's global period
  • Use 99212 (straightforward) or 99214 (moderate) based on complexity

Podiatry CPT Codes Billing Guidelines For Maximum Reimbursement

Following proper billing guidelines prevents claim denials and ensures accurate reimbursement. Key areas include modifier requirements, documentation standards, and frequency limits.

Documentation Requirements

Proper podiatry CPT codes and documentation support medical necessity and prevent claim denials.

Category Required Information
Diagnosis Linkage Link every procedure to appropriate ICD-10 code
Laterality Specify right (RT), left (LT), or bilateral (-50) for all procedures
Medical Necessity Document why procedure is needed now and what conservative treatments failed
Systemic Conditions Note diabetes status, peripheral vascular disease, neuropathy
Clinical Findings Record specific Class A/B/C findings for Q-modifiers
Substance Details For injections, note medication name, NDC code, dosage, and volume
Wound Details Measure and document size (length × width), depth, tissue type, drainage
Time For E/M codes, document total time spent when using time-based coding

Confused by varying state Medicaid telehealth requirements?

Get Expert Help

Medicare Q-Modifiers Requirements

Q-modifiers are required when billing routine foot care codes (11055-11057, 11719-11721, G0127) to Medicare. These modifiers indicate the patient has qualifying conditions that make routine foot care medically necessary.

Q-Modifier Selection Guide:

Modifier Qualifying Findings Requirements
Q7 Class A finding Non-traumatic amputation of foot or integral skeletal portion
Q8 Two Class B findings Absent dorsalis pedis pulse + absent posterior tibial pulse, OR advanced trophic changes (3+ of: decreased hair growth, nail thickening, pigmentary changes, thin/shiny skin, rubor)
Q9 One Class B + Two Class C findings Class B: Absent pulse, advanced trophic changes
Class C: Claudication, temperature changes, edema, paresthesias, burning

Key Points:

  • All findings must be from the same foot
  • Always use with LT/RT modifiers to indicate laterality
  • Not required for patients with neuropathy alone without vascular impairment
  • Document specific findings in clinical notes to support modifier selection

Modifier -25 for Same-Day E/M Services

Modifier -25 indicates a significant, separately identifiable E/M service on the same day as a procedure.

When to Use Documentation Requirements
E/M service addresses different problem than procedure Document separate chief complaint and medical decision-making
E/M service significantly exceeds usual pre/post-procedure work Show additional history, exam, or counseling beyond procedure
Decision to perform procedure made during E/M visit Note evaluation that led to procedure decision

Common Scenarios Requiring Modifier -25

  • Patient presents for nail debridement evaluation; physician also addresses unrelated ankle pain
  • Established patient visit where decision is made to perform injection
  • Post-operative visit where new problem is evaluated and managed

What Does NOT Qualify

  • Routine pre-procedure assessment
  • Minimal history and exam related only to the procedure
  • Post-procedure check included in global period

Frequency Limitations

Many podiatry CPT codes have frequency limits under Medicare and commercial payers. Exceeding these limits without proper documentation results in claim denials.

CPT Code Frequency Limit Documentation for Exception
11721 Once per 60 days Document accelerated nail growth, patient non-compliance with home care, or medical necessity for more frequent treatment
11730 Same digit: 4 months (finger), 8 months (toe) Document recurrent ingrown nail, failed previous procedure, or new trauma
11750 Same digit: Prior approval needed Use KX modifier and document failed 11730, chronic recurrence, or infection
20610 3-4 injections per year typical Document continued pain, failed conservative treatment, therapeutic trial rationale

Conclusion:

If you encounter a denial, it’s highly likely because of these three reasons: incorrect Q-modifiers, using 11721 when you treated four nails, and writing “wound care done” with no depth or measurements. Medicare’s catching these faster now, and the appeals aren’t worth your time. Go through your 11721 claims from last month. Check if Q7, Q8, or Q9 actually matches what’s documented.

Put the 60-day frequency limit somewhere your front desk can see it. Add required fields to your EMR templates for wound size and tissue depth. If this sounds like one more thing your billing staff doesn’t have bandwidth for, that’s where MedCare MSO comes in; we choose the appropriate podiatry CPT codes, handle the Q-modifier matching and frequency tracking so denials stop eating into your collections.

Content

Want to Improve Your Revenue Growth? 

By outsourcing your billing services to us, you can expect revenue growth of up to 20%

Request a Consultation
Request Demo

Lets get connected

Please provide the following information, so our team can connect with you within 12 hours.
Or call us as 800-640-6409

1 Step 1
Let’s Get in Touch

If you’d like to talk to someone now, give us a call at 800-640-6409. ​
To request a call back, just fill out this form. Please let us know your interest so we can be sure to have the best person call you.

reCaptcha v3
keyboard_arrow_leftPrevious
Nextkeyboard_arrow_right