CPT 28100 Talus/Calcaneus Excision Reimbursement | OpenPayer

Summary & Overview

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

CPT code 28100 designates the excision or curettage of a bone cyst or benign tumor of the talus or calcaneus, a targeted orthopedic procedure to reduce pain and restore ankle and hindfoot function. Nationally, this code captures a specialized surgical intervention used by orthopedic and podiatric surgeons treating benign osseous lesions of the hindfoot. Its use influences hospital and ambulatory surgical center case mix and can affect payer coverage and prior authorization patterns for foot and ankle surgery.

Key payers included in the scope of this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and which payers commonly adjudicate claims for this service. The publication outlines common billing considerations, prevalent modifiers used with this code, and related coding areas where available. It also provides benchmarking context and policy-relevant issues affecting surgical management of benign talar and calcaneal lesions, including authorization and setting-of-care implications.

This summary is intended for coding professionals, revenue cycle managers, and clinical leaders seeking a national overview of CPT code 28100—its clinical purpose, payer coverage landscape, and areas to monitor for coding and reimbursement implications.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare28100CPTOrthopedic SurgeryPodiatryFoot and AnkleSurgical ProcedureBone CystAmbulatory SurgeryHospital Outpatient

Billing Code Overview

CPT code 28100 describes the surgical excision or curettage of a bone cyst or benign tumor located in the talus or calcaneus. The procedure is performed to relieve pain and improve range of motion in the affected hindfoot bones.

Service type: Surgical procedure (osseous lesion excision/curettage)
Typical site of service: Inpatient or outpatient operating room or ambulatory surgical center specializing in orthopedic or podiatric surgery

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 35-year-old recreational runner presents with progressive pain and limited subtalar motion of the hindfoot after several months of intermittent deep ankle pain. Imaging with foot radiographs and MRI reveals a benign unicameral bone cyst within the calcaneus (or talus) causing cortical thinning and recurrent discomfort despite conservative care (activity modification, immobilization, and analgesics). The orthopedic foot and ankle surgeon schedules surgical excision and curettage of the cyst to decompress the lesion, remove pathological tissue, and improve pain and range of motion.

The clinical workflow includes preoperative evaluation with focused history and physical, imaging review, informed consent, perioperative anesthesia evaluation, operative curettage and possible grafting or local adjuvant, postoperative immobilization or splinting, and short-term follow-up for wound check and progressive weight-bearing as tolerated.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when reporting only the physician’s professional component when separate from technical services during facility billing.
`50`	Bilateral procedure

CPT 28119: Calcaneus Resection with Possible Plantar Fascial Release

CPT-28153-TOE-AMPUTATION-DISTAL-PHALANX-CONDYLE-REMOVAL

CPT 28153: Toe Amputation, Distal Phalanx Condyle Removal

CPT-28090-FOOT-TENDON-LESION-EXCISION-SYNOVECTOMY

CPT 28090: Excision of Foot Tendon Lesion with Synovectomy

CPT-28055-BURSAL-EXCISION-WITH-NERVE-DISSECTION-NEURECTOMY

CPT 28055: Bursal Excision with Nerve Dissection/Neurectomy

CPT-28050-FOOT-JOINT-EXPLORATION-SOFT-TISSUE-BIOPSY

CPT 28050: Foot Joint Exploration with Soft Tissue Biopsy

CPT-28175-PHALANX-TUMOR-RESECTION-RADICAL-RESECTION

CPT 28175: Radical Resection of Phalanx for Tumor

CPT-28102-TALUS-CALCANEUS-BONE-CYST-AUTOGRAFT

CPT 28102: Excision of Talus/Calcaneus Bone Cyst with Autograft

CPT-28124-TOE-PHALANX-EXCISION-CRATERIZATION-SAUCERIZATION

CPT 28124: Toe Phalanx Excision with Craterization or Diaphysectomy

CPT-28130-TALUS-EXCISION-ASTRAGALUS-REMOVAL-ANKLE-STABILIZATION

CPT 28130: Excision of Astragalus (Talus) for Ankle Stabilization

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
207L00000X	Orthopedic Surgery	Foot and ankle surgeons commonly perform `28100`.
207LP2900X	Orthopedic Surgery of the Lower Extremity	Subspecialty focused on hindfoot procedures.
208U00000X	Podiatry	Podiatric surgeons perform surgical management of calcaneal/talar lesions.
2080P0027X	Foot Surgery	Podiatric foot surgery taxonomy relevant for operative coding.
213E00000X	Pediatric Orthopedic Surgery	When the procedure is performed in pediatric patients with bone cysts.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M84.4`	Pathological fracture, not elsewhere classified	Bone cysts of the calcaneus or talus can predispose to pathological fracture requiring curettage.
`M85.8`	Other specified disorders of bone density and structure	Captures benign bone lesions affecting structure that may prompt excision.
`D16.1`	Benign neoplasm of bone and articular cartilage of lower limb, including pelvis	Directly describes benign bone tumors of the talus or calcaneus treated with excision/curettage.
`M89.9`	Disorder of bone, unspecified	Used when a specific bone disorder diagnosis is not otherwise specified but surgical treatment is needed.
`S92.9`	Fracture of foot, unspecified	Utilized if the cyst has contributed to a foot fracture requiring operative management.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11010`	Debridement including removal of foreign material and necrotic tissue from skin, subcutaneous tissue, muscle and fascia (includes simple wound debridement)	May be used if additional wound or soft tissue debridement is required at the time of cyst curettage.
`20930`	Allograft, morselized, or placement of osteoprogenitor material	Used when bone grafting or graft substitute is placed into the defect after curettage of the cyst.
`27600`	Arthrotomy, ankle; exploration, drainage, or synovectomy (specify)	May be performed if intra-articular extension or joint involvement requires exploration in conjunction with `28100`.
`29881`	Endoscopic, arthroscopy, ankle, diagnostic with/without synovial biopsy	Used when arthroscopic evaluation is performed for intra-articular evaluation prior to or in conjunction with cyst excision.
`28820`	Excision, calcaneal bone growth (e.g., calcaneal exostosis)	Related hindfoot bone procedures that may be performed in the same operative session for combined pathology.

OpenPayer