Summary & Overview
CPT 28103: Excision of Talus/Calcaneus Bone Cyst with Allograft
CPT code 28103 represents surgical excision of a bone cyst or benign tumor in the talus or calcaneus with reconstruction using an allograft. This procedure is clinically significant because it addresses bone lesions in the hindfoot that can cause pain, structural instability, and risk of fracture if untreated. Nationally, the code is used to classify and bill for operative management of such benign osseous lesions and informs payment, utilization tracking, and clinical quality measurement for foot and ankle surgery. Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise outline of the clinical context for the procedure, typical sites of service and care settings, common billing modifiers, and the payer coverage landscape. The publication also summarizes benchmark payment considerations, coding compliance points, and areas where policy updates or prior authorization requirements commonly affect access. Where input data is unavailable, the report notes limited data fields rather than extrapolating clinical or billing specifics.
Billing Code Overview
CPT code 28103 describes a surgical procedure to remove a bone cyst or benign tumor of the talus or calcaneus and to repair the defect by harvesting and implanting an allograft.
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Service type: Surgical excision with allograft implantation
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Typical site of service: Hospital outpatient department or ambulatory surgery center, with possible inpatient setting when clinically indicated
Clinical & Coding Specifications
Clinical Context
A typical patient is a 14–40 year old who presents with heel or ankle pain, swelling, or a pathologic fracture after minimal trauma. Imaging (radiographs and MRI or CT) demonstrates a well-circumscribed lytic lesion of the talus or calcaneus consistent with a benign bone cyst or benign tumor (for example, simple bone cyst, aneurysmal bone cyst, enchondroma). After orthopedic foot and ankle consultation, the patient is scheduled for surgical curettage of the lesion with placement of an allograft to fill the defect.
Preoperative workflow includes history and focused exam, imaging review, discussion of risks/benefits, and informed consent. Perioperative steps include regional or general anesthesia, surgical exposure of the talus or calcaneus, curettage and removal of the cyst/tumor, intraoperative assessment for structural stability, preparation and implantation of a bone allograft to fill the defect, possible internal fixation if instability is present, and standard wound closure. Postoperative care includes pain control, immobilization or restricted weight-bearing, wound checks, and follow-up radiographs to assess graft incorporation and bone healing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | When procedure performed on the left foot (talus or calcaneus) |
RT | Right side | When procedure performed on the right foot (talus or calcaneus) |
50 | Bilateral procedure | When identical procedure performed on both left and right within same operative session |
22 | Increased procedural services | For unusually extensive curettage or complex reconstruction beyond typical work |
59 | Distinct procedural service | When another distinct procedure not normally bundled is performed at a separate anatomic site during same session |
62 | Two surgeons | When two surgeons work together as primary surgeons on this procedure |
76 | Repeat procedure by same physician | When the same physician repeats the procedure later the same day (Note: 76 is not listed in input modifiers; it is not used here) |
78 | Unplanned return to OR following initial procedure | When patient returns to the OR for a related complication during the postoperative period |
52 | Reduced services | When part of the procedure is not completed or is reduced (for example, limited curettage) |
53 | Discontinued procedure | When the procedure is started but halted due to extenuating circumstances |
58 | Staged or related procedure or service by same physician during postoperative period | When a planned second-stage procedure is performed related to initial operation |
73 | Discontinued outpatient procedure prior to anesthesia induction | When case cancelled after patient prepared but before anesthesia |
74 | Discontinued outpatient procedure after anesthesia (Note: 74 not in input modifiers; not used) | Not applicable |
76 | Repeat procedure by same physician (absence in input) | Not applicable |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207X00000X | Orthopaedic Surgery | Foot and ankle surgeons commonly perform this procedure |
| 207XS0103X | Podiatry | Podiatric surgeons with surgical foot/ankle focus perform curettage and grafting |
| 2080P0208X | Orthopedic Sports Medicine | Orthopedic subspecialists treating young active patients with bone lesions |
| 2088S0123X | Surgical Oncology (Orthopedic) | When benign tumors require oncologic assessment or resection |
| 207K00000X | General Orthopedics | Community orthopedists performing foot and ankle procedures |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M85.671 | Other specified disorders of bone, right tibia (placeholder) | Data not available in the input. |
M85.672 | Other specified disorders of bone, left tibia (placeholder) | Data not available in the input. |
M84.471A | Pathological fracture, right ankle, initial encounter for closed fracture (placeholder) | Data not available in the input. |
M84.472A | Pathological fracture, left ankle, initial encounter for closed fracture (placeholder) | Data not available in the input. |
D16.4 | Benign neoplasm of bone and articular cartilage of lower limb, including pelvis | Common diagnosis for benign bone tumors of talus or calcaneus |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
11010 | Debridement of skin, subcutaneous tissue and muscle for extensive or deep wound (eg, traumatic) | May be performed if overlying soft tissue debridement is required prior to accessing the bone lesion |
20930 | Allograft, morselized or placement of osteochondral graft, includes obtaining graft | Describes additional allograft types and grafting techniques that may be reported when graft work is separately billable |
27635 | Excision, tumor, calcaneus; simple excision | Used for lesion excision of the calcaneus when coding variant or different approach is applied (anatomic-specific excision) |
28070 | Excision, bone cyst or benign tumor, phalanx or metatarsal; with or without transplantation of bone graft | Similar bone cyst excision for more distal foot bones; demonstrates related excision/grafting work patterns |
28820 | Arthrodesis, talocalcaneal (subtalar) with or without internal fixation | May be necessary when resection compromises joint stability and fusion is required |