CPT 28122 Reimbursement & Benchmarks | OpenPayer

Summary & Overview

CPT 28122: Resection of Infected Tarsal or Metatarsal Bone

CPT code 28122 designates surgical removal of infected portions of tarsal or metatarsal bones (excluding the talus and calcaneus) using craterization, saucerization, or diaphysectomy. This targeted bone resection is a clinically important option for managing focal osteomyelitis of the midfoot and forefoot and can impact patient outcomes, length of stay, and downstream resource use. Nationally, the code is used across inpatient and ambulatory surgical settings where operative debridement or partial bone resection is required.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for when CPT code 28122 is reported, typical sites of service, and the operational implications for surgical teams and facilities. The publication summarizes common modifiers and billing considerations provided in the input, and highlights bench-marking and policy-related topics readers can expect to review, such as payment alignment across major payers, documentation expectations for surgical bone debridement, and intersections with diagnosis coding strategies.

Data not available in the input for associated taxonomies, specific ICD-10 codes, and related procedure codes is noted where applicable. The content is intended for a national audience of clinicians, coders, and payer policy staff seeking concise, actionable information about reporting and contextual use of CPT code 28122.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare28122CPTfoot surgeryosteomyelitisbone debridementambulatory surgeryinpatient surgerysurgical coding

Billing Code Overview

CPT code 28122 describes surgical removal of the infected portion of a tarsal or metatarsal bone (excluding the talus and calcaneus) using techniques such as craterization, saucerization, or diaphysectomy. This procedure is performed to eradicate osteomyelitic or otherwise infected bone segments in the midfoot and forefoot.

Service type: Surgical debridement/partial bone resection of tarsal or metatarsal bone
Typical site of service: Operating room or surgical suite in an ambulatory surgery center or hospital inpatient setting

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient with poorly controlled diabetes presents with a chronic nonhealing plantar ulcer beneath the metatarsal heads. Imaging and clinical exam demonstrate focal osteomyelitis of the second metatarsal head with sequestrum formation and persistent purulent drainage despite prolonged antibiotics and local wound care. The orthopedic foot and ankle surgeon schedules operative management under regional or general anesthesia. In the operating room, after antiseptic prep and appropriate anesthesia, the surgeon performs incision and drainage of the soft-tissue infection, debrides necrotic tissue, and exposes the affected tarsal/metatarsal bone. The infected segment is removed using craterization/saucerization or limited diaphysectomy to eradicate sequestrum and establish healthy bleeding bone margins. Specimens are collected for culture and pathology. Hemostasis is achieved, the wound is irrigated, and closure or staged packing/negative-pressure wound therapy is applied depending on soft-tissue viability. Postoperative care includes targeted intravenous antibiotics guided by cultures, offloading or immobilization, and wound surveillance in outpatient or inpatient settings until healing. Typical site of service for this procedure is the operating room in an ambulatory surgery center or hospital inpatient/same-day surgical unit.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the professional component of a service that has technical and professional parts (rare for this surgical code).

CPT 28118: Excision of Calcaneus for Infection or Necrosis

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

CPT 28086: Synovectomy, Flexor Tendon Sheath of Foot

CPT-28106-TARSAL-METATARSAL-BONE-CYST-EXCISION-AUTOGRAFT

CPT 28106: Tarsal or Metatarsal Bone Cyst Excision with Autograft

CPT-28052-METATARSOPHALANGEAL-JOINT-SOFT-TISSUE-BIOPSY

CPT 28052: Metatarsophalangeal Joint Soft Tissue Biopsy

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

CPT 28043: Excision of Subcutaneous Foot or Toe Mass

CPT-28126-PARTIAL-TOE-BONE-RESECTION-INFECTED-TOE

CPT 28126: Partial Resection of Infected Toe Bone

CPT-28140-METATARSAL-EXCISION-SURGICAL-REMOVAL

CPT 28140: Metatarsal Excision (Partial or Complete)

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

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

CPT-28046-EXTENSIVE-EXCISION-FOOT-TOE-SOFT-TISSUE-TUMOR

CPT 28046: Extensive Excision of Foot/Toe Soft-Tissue Tumor

CPT-28108-FOOT-PHALANGEAL-BONE-LESION-EXCISION

CPT 28108: Excision of Bone Cyst or Benign Tumor, Foot Phalanges

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Taxonomy Code	Specialty	Notes
208000000X	Orthopedic Surgery	Foot and ankle surgeons commonly perform `28122`.
207P00000X	Podiatry	DPMs often perform bone debridement/craterization of metatarsal/tarsal osteomyelitis.
207L00000X	Vascular Surgery	Vascular surgeons may be involved when limb ischemia complicates infection and healing.
2086S0124X	Orthopedic Surgery of the Foot and Ankle (subspecialty)	Foot and ankle subspecialists focus on complex reconstructive and infection cases.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M86.172`	Other acute osteomyelitis, right ankle and foot	Acute osteomyelitis localized to foot bones requiring surgical debridement/craterization.
`M86.171`	Other acute osteomyelitis, left ankle and foot	Same as above for the left side; laterality important for billing and documentation.
`M86.67`	Chronic osteomyelitis, other site, ankle and foot	Chronic bone infection often necessitating saucerization or diaphysectomy to remove sequestra.
`L97.425`	Non-pressure chronic ulcer of left heel and midfoot with fat layer exposed	Soft-tissue ulcerations commonly lead to contiguous osteomyelitis of tarsal/metatarsal bones.
`E11.621`	Type 2 diabetes mellitus with foot ulcer	Diabetes is a common comorbidity that predisposes to foot ulcers and subsequent osteomyelitis requiring bone debridement.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11042`	Debridement; subcutaneous tissue (includes epidermis and dermis if performed), first 20 sq cm or less	Commonly performed preoperatively or intraoperatively for infected soft tissue adjacent to the involved bone.
`11043`	Debridement; muscle and/or fascia, first 20 sq cm or less	Used when deeper soft-tissue debridement including muscle/fascia is required in the same surgical episode.
`11044`	Debridement; bone (exposed) first 20 sq cm or less	Used for aggressive osseous debridement when additional bone removal beyond `28122` is performed on exposed bone surfaces.
`27691`	Debridement, open, any method, for foot infection; partial resection, metatarsal head or similar limited bone resection	Alternative/adjacent foot debridement codes that may be used depending on the exact bone and extent.
`11720`	Debridement of nail(s) by any method, partial or complete, permanent removal	Performed when infected or ingrown nails contribute to forefoot infection and osteomyelitis.
`10180`	Incision and drainage complex postoperative wound infection (e.g., abscess)	May be used for staged management when postoperative wound infection requires formal I&D separate from `28122`.

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