Summary & Overview
CPT 28106: Tarsal or Metatarsal Bone Cyst Excision with Autograft
CPT code 28106 denotes surgical excision of a bone cyst or benign tumor in the tarsal or metatarsal region with harvest and implantation of an autograft to fill the defect. This code captures a combined resection-and-reconstruction procedure relevant to orthopedic and podiatric surgery, important for appropriate claims classification and payment across surgical settings. Nationally, correct use of this code supports accurate reporting of complex foot and ankle procedures and informs utilization and cost monitoring for musculoskeletal surgical care.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication covers payer-specific coverage considerations and common modifier usage where available, benchmarking against national reimbursement patterns. Readers will find a concise clinical context for the procedure, guidance on typical sites of service, and a summary of what to expect in payer policies and claim adjudication. The piece highlights benchmarks, recent policy updates when applicable, and operational considerations for coding and billing teams managing foot and ankle surgical claims. Data not provided in the input (such as specific payer rates, associated taxonomies, and ICD-10 pairings) is noted as unavailable in the input.
Billing Code Overview
CPT code 28106 describes the surgical removal of a bone cyst or benign tumor located in the tarsal or metatarsal region, followed by harvesting and implantation of an autograft to fill the resulting osseous defect. This procedure typically involves excision of the lesion and reconstruction using the patient’s own bone to restore structural integrity.
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Service type: Surgical excision with autograft reconstruction
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Typical site of service: Operative setting, commonly performed in an ambulatory surgery center or hospital operating room
Clinical & Coding Specifications
Clinical Context
A 32-year-old otherwise healthy male presents with progressive dorsal midfoot pain and intermittent swelling after several months of activity-related discomfort. Imaging (plain radiographs and MRI) demonstrates a well-circumscribed lytic lesion within the second metatarsal consistent with a benign bone cyst. Conservative management including activity modification and immobilization failed. The orthopedic foot and ankle surgeon schedules operative management: curettage and removal of the bone cyst with harvest of an autologous cancellous bone graft (commonly from the ipsilateral proximal tibia or calcaneus) and implantation into the defect to restore structural integrity. The procedure is performed in an ambulatory surgery center under regional or general anesthesia. Intraoperative fluoroscopy confirms adequate evacuation of the lesion and graft packing. Postoperative workflow includes recovery room monitoring, discharge with weight-bearing restrictions or immobilization, wound care instructions, scheduled follow-up for suture removal and radiographic assessment of graft incorporation, and physical therapy as indicated for gait restoration.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural service | Use when documentation supports substantially greater work than typical for the code due to complexity or extended operative time. |