Summary & Overview
CPT 28043: Excision of Subcutaneous Foot or Toe Mass
CPT code 28043 represents the excision of an abnormal subcutaneous mass of the foot or toe with submission of a specimen under 1.5 cm for laboratory analysis. Nationally, this code captures a common minor surgical procedure performed by podiatrists and other surgical providers for diagnostic and therapeutic management of localized lesions. Accurate coding of this service is important for clinical documentation, downstream pathology billing, and appropriate classification of outpatient surgical workload.
Key payers in scope for this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise synthesis of the code’s clinical definition and typical care setting, benchmarking context for payer policies and coverage patterns, and notes on common billing considerations tied to specimen submission. The content highlights how this code fits within outpatient minor surgery workflows and its relevance for pathology processing when lesion tissue is sent for analysis.
The publication provides clinicians, billing professionals, and policy analysts with a clear clinical description, payer coverage framing, and practical context for documenting and processing claims for excision of small subcutaneous foot or toe masses. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 28043 describes the excision of an abnormal mass located immediately below the skin of the foot or toe, with the specimen submitted for laboratory analysis and measuring less than 1.5 cm. The procedure involves removal of a subcutaneous lesion from the lower extremity focused on the foot or toes.
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Service type: Minor surgical excision of a subcutaneous foot or toe mass
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Typical site of service: Ambulatory surgical center or outpatient clinic procedure room
Clinical & Coding Specifications
Clinical Context
A 54-year-old patient presents to an outpatient podiatry clinic with a painful, palpable subcutaneous mass on the plantar surface of the forefoot, progressively enlarging over several months and causing pressure pain with ambulation. Physical exam reveals a well-circumscribed, mobile nodule beneath the skin of the foot, approximately 1.0 cm in greatest dimension. Local anesthesia is administered in the clinic procedure room, the skin is prepped and draped, an elliptical incision is made, and the abnormal subcutaneous mass is dissected free and removed intact. Hemostasis is achieved, the specimen less than 1.5 cm is placed in formalin and submitted to the pathology laboratory for analysis. The surgical site is closed with interrupted sutures. Typical site of service is an outpatient clinic or ambulatory surgery center. Typical service type is a minor surgical excision of a subcutaneous lesion of the foot/toe under local anesthesia with specimen submission for pathology.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, or complexity substantially exceeds typical for the procedure due to extensive dissection or unexpected difficulty. |
23 | Unusual anesthesia |