Summary & Overview

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

CPT code 28104 identifies surgical excision of a bone cyst or benign tumor in the tarsal or metatarsal region (excluding the talus and calcaneus). This code is used for procedures addressing osseous lesions of the midfoot and forefoot and is relevant to orthopedic, podiatric, and surgical billing nationwide. Accurate use of this code affects procedural classification, claim adjudication, and clinical documentation consistency.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and the types of surgical services represented by the code. The publication outlines common modifiers and coding considerations where provided, highlights national payer coverage themes, and summarizes what to expect for claim processing and documentation requirements. This resource is intended for coding professionals, billing managers, and clinicians who need a clear, operational summary of CPT code 28104 for national billing and reimbursement workflows.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 28104foot surgeryorthopedic surgerybone cyst excisiontarsal metatarsalprocedure codingsurgical billingambulatory surgeryhospital outpatient

Billing Code Overview

CPT code 28104 describes a surgical procedure for removal of a bone cyst or benign tumor located in the tarsal or metatarsal region, excluding the talus and calcaneus. The procedure involves excision of an osseous lesion within the midfoot or forefoot bones.

Service Type: Surgical excision of bone lesion (orthopedic foot surgery)

Typical Site of Service: Hospital outpatient department or ambulatory surgical center; may also occur in inpatient hospital settings when clinically indicated

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 28-year-old patient presents to an orthopedic foot and ankle clinic with progressive dorsal foot pain and a palpable mass over the midfoot that has slowly enlarged over several months. Physical exam demonstrates localized tenderness over the metatarsal region with limited push-off. Radiographs and MRI confirm a benign-appearing bone lesion (simple bone cyst or enchondroma) involving the second metatarsal, without involvement of the talus or calcaneus. The patient is scheduled for operative excision of the benign bone tumor from the metatarsal with possible curettage and bone grafting under general anesthesia. Typical workflow includes preoperative evaluation and imaging review in clinic, surgical consent and marking, intraoperative lesion removal and hemostasis, possible autograft/allograft placement, postoperative dressing and splinting, and routine follow-up visits for wound check and radiographic assessment of healing.

Coding Specifications

Modifier	Description	When to Use
`52`	Reduced services	Use when the excision is partially performed or limited compared to full procedure scope.
`53`	Discontinued procedure	Use if the procedure is started but halted due to unforeseen circumstances.
`59`	Distinct procedural service	Use to indicate a separate, independent procedure performed on the same day at a different site of the foot.
`62`	Two surgeons	Use when two surgeons of different specialties perform distinct portions of the operation together.
`76`	Repeat procedure by same physician	Use for an unplanned repeat of the same procedure during the postoperative period by the same provider.
`78`	Unplanned return to the operating room by same physician following initial procedure for a related procedure during the global period	Use when a complication (e.g., hematoma evacuation) requires reoperation.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when an unrelated foot procedure is performed during the global period.
`22`	Increased procedural services	Use when work required is substantially greater than usual (e.g., extensive dissection or reconstruction).
`51`	Multiple procedures	Use when multiple distinct procedures are performed during the same operative session (e.g., lesion excision plus tendon repair).
`50`	Bilateral procedure	Use if a similar lesion is excised from both feet in the same operative session.
`26`	Professional component	Use if billing solely for the physician’s professional component when the technical component is billed separately.
`TC`	Technical component	Use when billing only for technical component of a global service (e.g., facility billing for supplies/equipment).
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist service furnished in part-time	Use when applicable payor recognizes `AS` for services furnished by these non-physician providers during pre- or postoperative care under supervision.
`LT`	Left side	Use to specify laterality for procedures performed on the left foot.

Taxonomy Code	Specialty	Notes
`207NP0100X`	Podiatric Surgery	Podiatric surgeons commonly perform metatarsal and tarsal region tumor excisions.
`2080P0207X`	Orthopaedic Surgery	Orthopedic foot and ankle surgeons frequently perform surgical management of benign bone tumors of the foot.
`2084P0800X`	Orthopedic Surgery of the Foot and Ankle	Subspecialty taxonomy for practitioners focused on foot/ankle pathology.
`363L00000X`	General Surgery (not typical)	Occasionally involved for complex reconstructive cases requiring multidisciplinary care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M84.30`	Pathological fracture, unspecified site	Relevant when a benign bone lesion weakens the metatarsal leading to fracture risk.
`D16.4`	Benign neoplasm of bone and articular cartilage of lower limb, including hip	Represents benign bone tumors of the foot and lower extremity.
`M85.8`	Other specified disorders of bone density and structure	Used for non-neoplastic focal bone lesions requiring excision.
`M89.9`	Disorder of bone, unspecified	Used when a specific bone disorder diagnosis is not yet established preoperatively.
`S92.30`	Fracture of unspecified metatarsal bone, unspecified site	Used when the lesion has caused or is associated with a metatarsal fracture.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`20680`	Removal of implant; deep (e.g., buried wires, pins)	May be performed if hardware removal is required in the same operative session or during follow-up for lesion access.
`20930`	Allograft, morselized, or placement of osteochondral grafts	Used when bone grafting is required after curettage of the cyst or tumor.
`27096`	Incision and drainage, deep abscess, or hematoma of pelvis (not foot)	Data not applicable; placeholder avoided per rules — alternative related code below.
`27650`	Excision of lesion of soft tissue of heel/ankle; subcutaneous	Used when associated soft tissue excision adjacent to the bony lesion is required.
`11012`	Debridement of skin, subcutaneous tissue and muscle, up to 20 sq cm	Used for complex wound debridement if the lesion presentation includes ulceration or soft tissue compromise.