Summary & Overview
CPT 28035: Tarsal Tunnel Release, Posterior Tibial Nerve Decompression
CPT code 28035 is the designated Current Procedural Terminology code for surgical release of a fibrous band compressing the posterior tibial nerve to treat tarsal tunnel syndrome. This procedure addresses peripheral nerve entrapment in the lower leg and is clinically significant because it can relieve chronic pain, numbness, and paresthesia that impair mobility and quality of life. Nationally, accurate coding of this procedure affects surgical utilization metrics, postoperative care pathways, and reimbursement for orthopedic and podiatric practices.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, common settings where the procedure is performed, and typical billing considerations. The publication includes benchmarking expectations, payer coverage patterns, and relevant policy or coding guidance where available. Content is intended for coding specialists, surgical providers, and revenue cycle staff who need a clear, national-level summary of how CPT code 28035 is used and what factors commonly influence claim adjudication.
Billing Code Overview
CPT code 28035 describes a surgical procedure in which the provider incises a fibrous band that is compressing the posterior tibial nerve in the lower leg to relieve symptoms of tarsal tunnel syndrome, such as pain, numbness, and tingling. This procedure is a targeted peripheral nerve decompression performed to address entrapment neuropathy of the posterior tibial nerve.
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Service type: Surgical peripheral nerve decompression
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Typical site of service: Operating room or ambulatory surgical center, often performed under regional or general anesthesia
Clinical & Coding Specifications
Clinical Context
A 46-year-old patient presents to an orthopedic surgeon with a 12-month history of progressive medial ankle and plantar foot pain, burning paresthesia, and numbness worsened by prolonged standing and activity. Conservative management has included activity modification, ankle orthoses, nonsteroidal anti-inflammatory drugs, a course of physical therapy, and two ultrasound-guided corticosteroid injections with only transient relief. Nerve conduction studies and electromyography demonstrate delayed conduction of the posterior tibial nerve across the tarsal tunnel consistent with tarsal tunnel syndrome. Imaging (ankle MRI or ultrasound) excludes a space-occupying lesion but may show tenosynovitis and medial retinacular thickening.
The patient is scheduled for operative release of the flexor retinaculum and decompression of the posterior tibial nerve under regional or general anesthesia in an outpatient ambulatory surgery center. The operative workflow includes preoperative marking, regional block or general endotracheal anesthesia, a curvilinear incision posterior to the medial malleolus, careful neurolysis of the posterior tibial nerve and its branches, release of the flexor retinaculum and any constricting fibrous bands, hemostasis, and layered wound closure. Postoperative care includes short-term immobilization, pain control, wound checks, and a plan for progressive weight bearing and physical therapy. Typical clinical goals are resolution or reduction of pain, numbness, and tingling and restoration of function.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |