CPT 28124 Toe Phalanx Excision Reimbursement | OpenPayer

Summary & Overview

CPT 28124: Toe Phalanx Excision with Craterization or Diaphysectomy

CPT code 28124 denotes surgical removal of infected portions of a toe phalanx using craterization, saucerization, or diaphysectomy. Nationally, this code represents a targeted orthopedic/podiatric procedure used to manage focal osseous infection of the toe and can affect coding, coverage determination, and episode cost for lower-extremity surgical care. Key payers in typical analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

This publication provides a concise reference for clinicians, coders, and policy analysts. Readers will find: a clinical context for when the procedure is billed, typical sites of service, common payer coverage considerations, and benchmark-oriented content relevant to utilization and coding practice. The content summarizes how CPT code 28124 fits into surgical management of toe phalanx infections and what stakeholders should expect when encountering this code in claims and billing workflows. Data not available in the input.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 28124toe phalanxphalanx debridementpodiatric surgeryorthopedicssurgical procedureinfected bonecraterizationsaucerizationdiaphysectomy

Billing Code Overview

CPT code 28124 describes a surgical procedure in which the provider removes the infected portion of a toe phalanx using craterization, saucerization, or diaphysectomy. This procedure is aimed at excising diseased bone tissue from a toe phalanx to control infection and preserve surrounding structures.

Service type: Surgical bone debridement of a toe phalanx
Typical site of service: Ambulatory surgical center or hospital outpatient department; may also be performed in an operating room for inpatient cases

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult presenting with a chronic or acute toe infection involving the distal or proximal phalanx (osteomyelitis, infected nonhealing ulcer with exposed bone, or severe paronychia with bony involvement) that has failed conservative therapy (oral/IV antibiotics, wound care, partial nail removal). The patient often has comorbidities such as diabetes mellitus, peripheral vascular disease, or neuropathy that predispose to progressive soft-tissue and bony infection. Evaluation includes history, physical exam of the foot and toe, wound culture, laboratory studies (CBC, inflammatory markers), and imaging (plain radiographs; MRI if needed) confirming cortical destruction or sequestrum of the phalanx.

The clinical workflow: pre-procedure consent and medical clearance; perioperative antibiotics as indicated; local block or regional/general anesthesia; debridement of infected bone using craterization, saucerization, or diaphysectomy to remove sequestra and infected phalanx segments; copious irrigation; hemostasis and wound closure or partial closure with sterile dressing; postoperative instructions and follow-up for wound checks, continued antibiotics guided by culture, and consideration of further reconstruction if needed. Typical site of service is an outpatient ambulatory surgery center or hospital operating room depending on anesthesia and comorbidity. Service type: minor surgical procedure (osseous debridement/partial phalangeal resection) of the toe phalanx.

Coding Specifications

Modifier	Description	When to Use
`25`

CPT 28045: Excision of Foot/Toe Soft-Tissue Mass

CPT-28072-METATARSOPHALANGEAL-JOINT-SYNOVECTOMY

CPT 28072: Synovectomy, Metatarsophalangeal Joint

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

CPT 28153: Toe Amputation, Distal Phalanx Condyle Removal

CPT-28116-TARSAL-COALITION-EXCISION

CPT 28116: Excision of Tarsal Coalition

CPT-28173-RADICAL-RESECTION-METATARSAL-TUMOR

CPT 28173: Radical Resection of Metatarsal for Tumor

CPT-28055-BURSAL-EXCISION-WITH-NERVE-DISSECTION-NEURECTOMY

CPT 28055: Bursal Excision with Nerve Dissection/Neurectomy

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

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

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

CPT 28175: Radical Resection of Phalanx for Tumor

CPT-28130-TALUS-EXCISION-ASTRAGALUS-REMOVAL-ANKLE-STABILIZATION

CPT 28130: Excision of Astragalus (Talus) for Ankle Stabilization

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

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

Showing 1–10 of 45

Taxonomy Code	Specialty	Notes
207PR0100X	Podiatric Medicine & Surgery	Podiatrists commonly perform toe phalanx debridement and partial phalangectomy.
207L00000X	Orthopedic Surgery	Orthopedic foot and ankle surgeons perform phalangeal debridement when complex bony involvement exists.
207Q00000X	General Surgery	Some general surgeons with limb/wound expertise perform digital bone debridement in hospitals.
2080P0206X	Family Medicine	Family physicians with procedural scope in some ambulatory settings may perform minor toe procedures.
208000000X	Internal Medicine	Hospitalists/internists may provide perioperative medical management but rarely perform the operative procedure.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M86.171`	Acute osteomyelitis, right toe	Osteomyelitis of the toe phalanx is a primary indication for craterization/diaphysectomy.
`M86.172`	Acute osteomyelitis, left toe	Same relevance for left-sided toe bone infection.
`M86.271`	Subacute osteomyelitis, right toe	Subacute infections that fail conservative care may require surgical removal of infected bone.
`M86.272`	Subacute osteomyelitis, left toe	As above for left toe involvement.
`L03.011`	Cellulitis of right toe	Severe soft-tissue infection with underlying bone involvement can lead to need for phalangeal debridement.
`L03.012`	Cellulitis of left toe	As above for left toe.
`E11.621`	Type 2 diabetes mellitus with foot ulcer	Diabetic foot ulcers frequently progress to bone infection necessitating phalanx debridement.
`T84.7XXA`	Infection and inflammatory reaction due to internal fixation device, initial encounter	Relevant when prior implants or fixation near the toe become infected and bone debridement is required.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11055`	Drainage of finger abscess; simple	Performed when a soft-tissue abscess is present prior to or instead of bony debridement of the toe.
`11730`	Avulsion of nail plate, partial or complete, any number of nails	Often performed concurrently if toenail pathology or paronychia contributes to infection.
`11042`	Debridement; skin, subcutaneous tissue and muscle	Used for more extensive soft-tissue debridement of the foot that may accompany bony work.
`11043`	Debridement; skin, subcutaneous tissue, muscle and bone	Used for extensive debridement including bone when larger osseous involvement requires wider resection than toe phalanx-specific code.
`11750`	Excision of nail and nail matrix, partial or complete (e.g., for ingrown nail)	May be performed at same setting when nail disease contributes to infection.
`99213`	Office or other outpatient visit for evaluation and management	Pre- or post-operative E/M visits commonly billed in association with the procedure when documented as separate and distinct.

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