CPT 28092 Toe Tendon Sheath Excision Reimbursement | OpenPayer

Summary & Overview

CPT 28092: Excision of Toe Tendon/Tendon Sheath Lesion, May Include Synovectomy

CPT code 28092 represents surgical excision of a lesion involving the tendon, tendon sheath, or capsule of each toe and can include synovectomy of the extensor tendon sheath of the foot. This procedure addresses focal tendon or tenosynovial disease in the toes that requires operative removal and debridement. Nationally, the code is relevant to orthopedic foot and ankle surgeons, podiatrists, surgical centers, and payers managing coverage and claims for foot tendon procedures. Key payers covered in this publication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical and coding overview of the procedure, common billing and modifier considerations, and benchmarking context where available. The content outlines typical settings of care, clinical indications implied by the procedure description, and the kinds of documentation and claim components that are commonly reviewed by payers. Data not provided in the input—such as specific ICD-10 pairings, associated taxonomies, and payer-specific pricing—is noted as unavailable. This piece serves as a national reference for coding teams, billing professionals, and clinicians seeking a clear summary of what CPT code 28092 denotes and where it fits within surgical foot and ankle services.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 28092foot surgerytendon sheath excisionsynovectomyambulatory surgerypodiatryorthopedicsprocedure coding

Billing Code Overview

CPT code 28092 describes excision of a lesion of the tendon, tendon sheath, or capsule of each toe, and may include a synovectomy to remove inflamed or diseased synovium from the extensor tendon sheath of the foot. The procedure targets localized tendon or tendon sheath pathology in the toes and forefoot.

Service type: Surgical excision / tendon sheath surgery
Typical site of service: Ambulatory surgical center or hospital operating room; may also be performed in an outpatient surgical clinic with appropriate sterile setup

Data not available in the input for associated taxonomies or ICD-10 diagnoses.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 45–70-year-old ambulatory adult presenting with chronic, focal pain and swelling over the dorsal or lateral aspect of a toe, refractory to conservative care (NSAIDs, activity modification, orthotics, and local steroid injection). Examination demonstrates focal tenderness along a tendon or tendon sheath with pain on passive toe motion and possibly crepitus. Imaging (plain radiographs and ultrasound) excludes bony pathology and shows tenosynovitis or a localized diseased synovial sheath. The surgeon schedules a minor operative procedure in an outpatient ambulatory surgery center or hospital outpatient department to excise the pathological portion of the tendon, tendon sheath, or capsule of the affected toe. The service includes possible synovectomy of the extensor tendon sheath to remove inflamed synovium. Preoperative workflow includes history/physical, informed consent, review of imaging, and marking of the operative site. Intraoperative workflow involves regional or local anesthesia with sedation, a focused incision over the affected tendon, excision of the lesion and diseased synovium, hemostasis, and layered closure. Postoperative care includes wound care instructions, short course of analgesia, limited weightbearing as indicated, and a follow-up visit for suture removal and assessment of tendon function. Typical sites of service are the ambulatory surgery center or hospital outpatient department. The service type is minor surgical excision with limited soft-tissue synovectomy of the toe extensor tendon sheath; duration is generally brief and usually does not require inpatient admission.

Coding Specifications

Modifier	Description	When to Use
`50`

CPT 28118: Excision of Calcaneus for Infection or Necrosis

CPT-28100-TALUS-CALCANEUS-BONE-CYST-EXCISION-CURETTAGE

CPT 28100: Excision or Curettage of Bone Cyst or Benign Tumor, Talus/Calcaneus

CPT-28113-FIFTH-METATARSAL-HEAD-EXCISION-NECROSIS-INFECTION

CPT 28113: Excision of Fifth Metatarsal Head for Necrosis or Infection

CPT-28045-FOOT-TOE-SOFT-TISSUE-MASS-EXCISION

CPT 28045: Excision of Foot/Toe Soft-Tissue Mass

CPT-28171-RADICAL-RESECTION-TARSAL-BONE-TUMOR

CPT 28171: Radical Resection of Tarsal Bone for Tumor

CPT-28052-METATARSOPHALANGEAL-JOINT-SOFT-TISSUE-BIOPSY

CPT 28052: Metatarsophalangeal Joint Soft Tissue Biopsy

CPT-28047-EXTENSIVE-SOFT-TISSUE-TUMOR-EXCISION-FOOT-TOE-3CM-OR-MORE

CPT 28047: Extensive Soft Tissue Tumor Excision of Foot or Toe, ≥3 cm

CPT-28039-FOOT-TOE-SOFT-TISSUE-MASS-EXCISION-1-5CM-OR-GREATER

CPT 28039: Excision of Foot/Toe Soft-Tissue Mass, ≥1.5 cm

CPT-28070-INTERTARSAL-TARSOMETATARSAL-SYNOVECTOMY

CPT 28070: Synovectomy of Intertarsal or Tarsometatarsal Joint

CPT-28104-TARSAL-METATARSAL-BONE-CYST-EXCISION

CPT 28104: Excision of Bone Cyst or Benign Tumor, Tarsal/Metatarsal

Showing 1–10 of 45

Taxonomy Code	Specialty	Notes
207P00000X	Podiatric Surgery	Podiatric surgeons commonly perform toe tendon/tendon sheath excisions and synovectomies.
207L00000X	Foot and Ankle Orthopedic Surgery	Orthopedic foot and ankle surgeons frequently perform these procedures, often for chronic tenosynovitis or degenerative lesions.
207K00000X	Orthopedic Surgery	General orthopedic surgeons with foot/ankle focus may perform this procedure.
2080P0208X	Family Medicine — Podiatry Focus	In some systems, family medicine providers with procedural training may perform minor toe excisions in ambulatory settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M65.4`	Other synovitis and tenosynovitis	Directly describes synovial inflammation of tendon sheaths that may require excision or synovectomy.
`M65.9`	Synovitis and tenosynovitis, unspecified	Used when tenosynovitis is diagnosed without further specification but indicates the clinical problem targeted by this procedure.
`M77.4`	Peroneal tendinitis	Tendon inflammation of the foot/ankle region; may coexist or mimic toe extensor sheath disease requiring surgical management.
`M79.6`	Pain in limb	Symptom code used when focal limb/toe pain is documented as the indication for surgery.
`M20.2`	Hallux valgus (acquired)	Structural toe deformity that can cause tendon sheath irritation; may be present concurrently and influence surgical planning.
`M21.6`	Acquired deformity of toe(s)	Toe deformities that alter tendon mechanics and predispose to tendon sheath pathology addressed during surgery.
`L60.0`	Ingrowing nail	May be a differential diagnosis for toe pain; rarely co-managed surgically with tendon sheath excision if both conditions are present.
`M13.9`	Arthritis, unspecified	Inflammatory or degenerative joint disease near the tendon sheath can contribute to synovitis necessitating synovectomy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11055`	Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion	May be performed preoperatively in clinic for symptomatic lesions or concurrently for adjacent skin pathology but is a superficial skin procedure distinct from tendon excision.
`11400`	Excision, benign lesion including margins, trunk, arms, legs; excised diameter 0.5 cm or less	Used when a skin lesion overlying the tendon sheath requires excision in addition to deeper tendon sheath work; documents excision of cutaneous lesion separate from tendon procedure.
`28080`	Tenotomy, foot; percutaneous (e.g., for hammer toe)	Performed for tendon release procedures of the toes; may be an alternative or adjunct when tendon shortening/release is indicated rather than excision of a diseased sheath.
`28095`	Excision, lesion of tendon, tendon sheath, or capsule; toe, multiple	Use when multiple toes require excision in the same session — distinguishes single-toe (`28092`) from multiple-toe procedures.
`20610`	Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee); without ultrasound guidance	May be performed preoperatively for diagnostic or therapeutic aspiration/injection of adjacent tendon sheath or bursal inflammation.
`29280`	Applications of a splint (short leg to initial application)	Postoperative immobilization or protective splinting may be billed with appropriate documentation when provided after the procedure.

OpenPayer