CPT 28111 First Metatarsal Head Resection Reimbursement | OpenPayer

Summary & Overview

CPT 28111: Resection of First Metatarsal Head for Necrosis/Infection

CPT code 28111 denotes surgical resection of the first metatarsal head for necrosis or infection. Nationally, this procedure is clinically important for limb salvage, infection control, and pain relief in patients with localized metatarsal head bone loss. Procedural use affects surgical volumes, post-operative care needs, and resource allocation for foot and ankle services across inpatient and outpatient surgical settings.

Key payers included in coverage discussions are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and common billing considerations tied to CPT code 28111. The publication outlines typical utilization patterns, relevant coding considerations, and the types of benchmarks and policy updates that influence coverage and payment for this surgical service.

This summary equips clinicians, coding professionals, and payers with the context needed to interpret claims, understand clinical indications for the procedure, and identify where to look for payer-specific coverage policies and reimbursement guidance. Data not available in the input will be noted where applicable in detailed sections.

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Billing Code Overview

CPT code 28111 describes a surgical procedure that removes the bone of the first metatarsal head to treat necrosis or infection of the metatarsal head. This procedure is a form of bone resection performed on the first metatarsal to address localized osteonecrosis, septic processes, or nonviable bone tissue.

Service type: Surgical bone resection of the first metatarsal head
Typical site of service: Hospital operating room or ambulatory surgical center, depending on clinical severity and patient comorbidities

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient with long-standing diabetes mellitus and peripheral vascular disease presents with progressive right first metatarsal head pain, localized swelling, and a draining sinus after failed conservative care. Imaging (plain radiographs and MRI) demonstrates osteonecrosis and cortical destruction of the first metatarsal head consistent with advanced osteomyelitis. The surgical team schedules an operative procedure to debride infected bone and remove the necrotic first metatarsal head.

Preoperative workflow includes history and physical, review of laboratory markers (CBC, ESR, CRP), vascular assessment, and perioperative antibiotics guided by wound cultures. The procedure is typically performed under regional or general anesthesia in an outpatient ambulatory surgery center or hospital operating room. Intraoperative steps include incision and exposure of the first metatarsal head, removal/reaming of necrotic bone, culture-directed debridement, hemostasis, potential local antibiotic delivery, and layered closure. Postoperative care includes dressing changes, offloading, pain control, targeted antibiotics, and follow-up with podiatry or orthopedic foot and ankle specialists for wound surveillance and gait rehabilitation.

Coding Specifications

Modifier	Description	When to Use
`LT` / `RT`	Left / Right side designator	Use to specify side when procedure is performed on a single foot.

Related Codes

CPT-28116-TARSAL-COALITION-EXCISION

CPT 28116: Excision of Tarsal Coalition

CPT-28054-DIGITAL-JOINT-BIOPSY-TOE-FINGER

CPT 28054: Surgical Biopsy of Toe or Finger Joint

CPT-28107-TARSAL-METATARSAL-BONE-CYST-EXCISION-ALLOGRAFT

CPT 28107: Excision of Tarsal/Metatarsal Bone Cyst with Allograft

CPT-28043-FOOT-TOE-SUBCUTANEOUS-MASS-EXCISION

CPT 28043: Excision of Subcutaneous Foot or Toe Mass

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

CPT 28124: Toe Phalanx Excision with Craterization or Diaphysectomy

CPT-28110-FIFTH-METATARSAL-BONY-LESION-EXCISION

CPT 28110: Excision of Bony Lesion, Head of Fifth Metatarsal

CPT-28086-FOOT-FLEXOR-TENDON-SHEATH-SYNOVECTOMY

CPT 28086: Synovectomy, Flexor Tendon Sheath of Foot

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

CPT 28171: Radical Resection of Tarsal Bone for Tumor

CPT-28112-METATARSAL-HEAD-RESECTION-NECROSIS-INFECTION

CPT 28112: Metatarsal Head Resection for Necrosis or Infection

CPT-28092-TOE-TENDON-SHEATH-LESION-EXCISION-SYNOVECTOMY

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

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Taxonomy Code	Specialty	Notes
207N00000X	Podiatry	Podiatric surgeons commonly perform first metatarsal head resections for forefoot osteomyelitis or necrosis.
207L00000X	Orthopedic Surgery	Foot and ankle orthopedic surgeons perform metatarsal head resections and complex forefoot reconstructions.
2080P0004X	General Surgery (Podiatric)	General surgeons with foot/ankle focus may perform debridement in complex limb salvage cases.
185H00000X	Infectious Disease (consult)	Infectious disease specialists support perioperative antibiotic management and osteomyelitis treatment plans.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M86.171`	Acute osteomyelitis, right foot	Osteomyelitis of the first metatarsal head is a primary indication for resection of necrotic bone.
`M86.172`	Acute osteomyelitis, left foot	As above, for the left foot.
`M86.671`	Chronic osteomyelitis, right foot	Chronic infected bone often requires surgical resection of necrotic metatarsal head.
`M86.672`	Chronic osteomyelitis, left foot	As above, for the left foot.
`M86.9`	Osteomyelitis, unspecified	When laterality or acuity is not specified on initial documentation.
`L97.321`	Non-pressure chronic ulcer of right heel and midfoot with fat layer exposed	Forefoot ulcers may track to underlying bone and precipitate osteomyelitis requiring resection.
`E11.621`	Type 2 diabetes mellitus with foot ulcer	Diabetes with foot ulceration is a common comorbidity contributing to first metatarsal infection.
`I70.213`	Atherosclerosis of native arteries of right leg with rest pain	Peripheral vascular disease impairs healing and increases likelihood of surgical intervention.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11042`	Debridement, subcutaneous tissue, first 20 sq cm or less (includes removal of devitalized tissue)	May be performed prior to or in conjunction with metatarsal head resection for soft tissue infected debridement.
`11043`	Debridement, muscle and/or fascia, first 20 sq cm or less	Used when deeper soft-tissue debridement involving muscle/fascia is required along with bony resection.
`27695`	Excision or débridement of bone or cartilage (foot) — note: general code for small bone debridement	Alternative/additive code used in some workflows for adjacent bony debridement when applicable.
`11730`	Avulsion of nail plate, partial or complete, permanent removal	Performed if infected toenail or paronychia contributes to forefoot infection requiring removal at same setting.
`10120`	Incision and drainage, complex; postoperative wound dehiscence or cellulitis	May be used when abscess drainage or complex wound management is performed perioperatively.
`20680`	Removal of implant (deep)	Performed when infected hardware adjacent to the first metatarsal head requires explantation during the same operative episode.