CPT 28118 Calcaneus Excision Reimbursement | OpenPayer

Summary & Overview

CPT 28118: Excision of Calcaneus for Infection or Necrosis

CPT code 28118 represents surgical excision of the calcaneus, a procedure used to treat severe infection or necrosis of the heel bone. Nationally, this code is relevant for acute orthopedic and podiatric surgical care where limb salvage or infection control necessitates partial or complete removal of the calcaneus. It is typically performed in hospital operating rooms and may be associated with inpatient stays depending on clinical severity. Key payers considered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will learn the clinical context for use of CPT code 28118, the typical sites of service, and the types of cases that prompt billing under this code. The publication also summarizes coverage and payment considerations across major national payers where available, benchmarking practices and identifying policy or billing issues that commonly arise with calcaneus excision procedures. Content addresses coding placement within surgical service lines and offers a concise reference for clinicians, coding professionals, and policy analysts seeking a national perspective on this specialized orthopedic surgical code. Data not available in the input for payer-specific rates, ICD-10 pairings, or related code utilization is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 28118calcaneus excisionorthopedic surgerypodiatric surgeryosteomyelitisbone resectionhospital inpatientsurgical procedure

Billing Code Overview

CPT code 28118 describes a surgical procedure for removal of the calcaneus (heel) bone performed when the bone is infected or necrotic. The procedure involves excision of the calcaneus to manage severe osteomyelitis, progressive bone necrosis, or life- or limb-threatening infection not responsive to conservative care.

Service type: Surgical excision / resection of bone (orthopedic surgery)
Typical site of service: Hospital operating room or inpatient surgical setting

Clinical & Coding Specifications

Clinical Context

A 58-year-old male with poorly controlled diabetes presents with progressive heel pain, purulent drainage from a chronic plantar ulcer, and signs of systemic infection despite prolonged antibiotics. Imaging (radiograph and MRI) demonstrates osteomyelitis and necrosis of the calcaneus with collapse of the posterior calcaneal cortex. After multidisciplinary evaluation by podiatry/orthopedics and infectious disease, the decision is made to perform a calcaneal excision (28118) to remove the infected/necrotic bone. The clinical workflow includes preoperative optimization (glycemic control, vascular assessment, and culture-directed antibiotics), preoperative anesthesia evaluation, intraoperative removal of the calcaneus with debridement of surrounding infected soft tissue, specimen submission for culture and pathology, and postoperative wound management with possible negative-pressure wound therapy and staged reconstruction or partial foot amputation if needed. Typical perioperative documentation includes indication (osteomyelitis/necrosis), imaging findings, informed consent, operative report detailing extent of bone removal, specimens sent, prosthetic/orthotic plans, and postoperative follow-up for wound healing and antibiotic course monitoring.

Coding Specifications

Modifier	Description	When to Use
`50`	Bilateral procedure	When both calcanei are operated on during the same operative session (rare).

CPT 28054: Surgical Biopsy of Toe or Finger Joint

CPT-28140-METATARSAL-EXCISION-SURGICAL-REMOVAL

CPT 28140: Metatarsal Excision (Partial or Complete)

CPT-28060-PARTIAL-PLANTAR-FASCIECTOMY-PLANTAR-FASCIA-RELEASE

CPT 28060: Partial Plantar Fasciectomy for Plantar Fascia Decompression

CPT-28111-FIRST-METATARSAL-HEAD-RESECTION-NECROSIS-INFECTION

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

CPT-28088-FOOT-EXTENSOR-TENDON-SHEATH-SYNOVECTOMY

CPT 28088: Synovectomy of Extensor Tendon Sheath, Foot

CPT-28080-MORTONS-NEUROMA-EXCISION-FOREFOOT-SURGERY

CPT 28080: Excision of Morton's Neuroma, Forefoot Surgery

CPT-28119-CALCANEUS-RESECTION-HEEL-BONE-REMOVAL

CPT 28119: Calcaneus Resection with Possible Plantar Fascial Release

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

CPT 28175: Radical Resection of Phalanx for Tumor

CPT-28150-TOE-PHALANX-EXCISION

CPT 28150: Excision of One Toe Phalanx

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

CPT 28153: Toe Amputation, Distal Phalanx Condyle Removal

Showing 1–10 of 45

Taxonomy Code	Specialty	Notes
`207P00000X`	Podiatric Medicine & Surgery	Podiatrists commonly perform calcaneal procedures for severe infection or necrosis.
`207L00000X`	Orthopedic Surgery	Orthopedic foot and ankle surgeons perform calcaneal excision and complex reconstructions.
`208000000X`	General Surgery	In some settings, general surgeons with vascular or limb salvage expertise may participate.
`2086S0120X`	Plastic and Reconstructive Surgery	Plastic surgeons commonly participate in soft tissue coverage and reconstruction after excision.
`363A00000X`	Infectious Disease	Infectious disease specialists manage perioperative and long-term antimicrobial therapy.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M86.17`	Chronic osteomyelitis, calcaneus	Direct indication for calcaneal excision when infection is refractory to conservative care.
`M86.171`	Chronic osteomyelitis with draining sinus, right calcaneus	Documents laterality and draining sinus commonly seen with calcaneal infection requiring surgery.
`M86.172`	Chronic osteomyelitis with draining sinus, left calcaneus	As above for left-sided disease.
`M86.9`	Osteomyelitis, unspecified	Used when site-specific coding is not yet determined but osteomyelitis is present.
`L97.422`	Non-pressure chronic ulcer of left heel and midfoot with necrosis of muscle	Chronic heel ulcers that expose or seed the calcaneus and lead to osteomyelitis.
`L97.421`	Non-pressure chronic ulcer of right heel and midfoot with necrosis of bone	Heel ulcerations with bone involvement that may necessitate calcaneal excision.
`E11.621`	Type 2 diabetes mellitus with foot ulcer	Diabetes is a common comorbidity contributing to poor wound healing and calcaneal infection.
`I96`	Gangrene, not elsewhere classified	Severe ischemia and tissue necrosis that may accompany or complicate calcaneal infections and prompt excision.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11042`	Debridement; skin, subcutaneous tissue, and muscle — first 20 sq cm or less	May be performed preoperatively or intraoperatively to remove overlying infected soft tissue before or alongside `28118`.
`11043`	Debridement; involving bone and/or cartilage — first 20 sq cm or less	When additional osseous debridement beyond calcaneal excision is required, this code may be reported for debridement of adjacent infected bone.
`28080`	Excision, plantar fibroma, partial calcaneal procedures (example ancillary code)	Related partial calcaneal or heel procedures that may be performed in conjunction with calcaneal surgery for wound management or bony pathology.
`20610`	Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., ankle)	Preoperative diagnostic aspiration or injection for culture or therapeutic purposes in the perioperative course.
`11045`	Debridement, extensive; involves down to bone, more than 20 sq cm	Used when large soft-tissue and bone debridement areas accompany calcaneal excision.

OpenPayer