Summary & Overview
CPT 28045: Excision of Foot/Toe Soft-Tissue Mass
CPT code 28045 denotes surgical excision of an abnormal soft-tissue mass from within the muscles of the foot or toe, with specimen submission under 1.5 cm for laboratory analysis. The code is relevant nationally for foot and ankle surgeons, podiatrists, and health systems managing benign and malignant soft-tissue lesions of the distal lower extremity. Accurate coding affects clinical documentation, pathology processing, and claims adjudication across commercial and public payers.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on clinical indications and typical sites of service for the procedure, common billing considerations, and comparative coverage patterns among major payers. The publication summarizes national benchmarks where available, highlights areas where policy language commonly affects payment and documentation, and outlines the clinical workflow tied to specimen submission for pathology.
The content is intended for coding professionals, billing managers, clinical leaders, and policy analysts seeking a concise reference on CPT code 28045, its clinical scope, and implications for reimbursement and documentation. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 28045 describes excision of an abnormal mass located within the intrinsic muscles of the foot or toe. The procedure includes removal of a specimen smaller than 1.5 cm and submission of that specimen to a laboratory for pathological analysis to determine the lesion's nature.
-
Service type: Surgical excision of soft tissue mass within foot/toe musculature
-
Typical site of service: Ambulatory surgical center or hospital outpatient setting; may also be performed in an office-based surgical suite depending on clinical complexity and facility resources
Clinical & Coding Specifications
Clinical Context
A 46-year-old patient presents to a podiatry clinic with a several-month history of a slowly enlarging, painful lump deep within the intrinsic muscles of the plantar surface of the foot near the base of the toes. Conservative measures (shoe modification, corticosteroid injection) provided limited relief. Physical examination demonstrates a well-circumscribed, firm submuscular mass approximately 1.0 cm in greatest dimension, mobile with muscle contraction and tender to palpation. Imaging (ultrasound or MRI) localizes the lesion to the muscle belly without cortical bone involvement. The podiatric surgeon schedules an outpatient operative excision under regional block or monitored anesthesia care. During the procedure the surgeon makes a targeted incision, dissects to the muscle plane, excises the lesion in its entirety, and submits the specimen measuring less than 1.5 cm to surgical pathology for histologic analysis to determine benign versus malignant pathology. The typical workflow includes preoperative evaluation and consent, intraoperative specimen labeling and pathology requisition, immediate postoperative wound care and discharge instructions, and a follow-up visit for wound check and pathology review. Typical site of service is an ambulatory surgical center or hospital outpatient department; anesthesia may be local, regional block, or monitored anesthesia care depending on comorbidity and patient preference.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing separated professional interpretation for services that have a technical component (rare for excision but used if separate physician interpretation is billed) |