CPT 28130 Talus Excision Reimbursement | OpenPayer

Summary & Overview

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

CPT code 28130 denotes surgical excision of the astragalus (talus) to stabilize the ankle. This procedure is used in severe trauma, infection, avascular necrosis, or irreparable deformity where talar removal is necessary to achieve mechanical stability or infection control. Nationally, procedures involving talar excision are relatively uncommon but clinically significant due to their complexity, impact on mobility, and postoperative rehabilitation needs.

Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise presentation of what CPT code 28130 represents, the clinical context for its use, and the typical settings where the service is delivered. The publication summarizes benchmarks and coverage considerations where available, highlights relevant coding relationships, and outlines policy and clinical context important for billing and utilization review. Any unavailable input fields are noted as missing in the detailed sections. This national overview is intended to inform clinicians, coders, and policy analysts about the code’s clinical purpose, common sites of service, and the payer landscape relevant to utilization and coverage discussions.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare28130CPTorthopedic surgeryankle surgerytalusastragalusoperative procedurehospital servicesambulatory surgery

Billing Code Overview

CPT code 28130 describes a surgical procedure in which the provider removes the astragalus (talus) bone to stabilize the ankle. This operation is performed to address severe talar injury, infection, chronic instability, or deformity when removal of the talus is clinically indicated.

Service type: Surgical procedure (open orthopedic procedure on the ankle/talus)
Typical site of service: Hospital operating room or ambulatory surgical center, depending on clinical complexity and patient status

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 56-year-old patient presents with chronic, severe post-traumatic ankle instability and persistent pain after multiple intra-articular fractures of the distal tibia and talus. Conservative care including immobilization, bracing, physical therapy, and intra-articular corticosteroid injections failed to restore function or relieve pain. Imaging (weight-bearing radiographs and CT) demonstrates severe talar collapse, non-reconstructable comminution of the talus with secondary arthrosis of the tibiotalar and subtalar joints. The orthopedic foot and ankle surgeon determines that removal of the talus (astragalus) with ankle stabilization and reconstruction is necessary to achieve a stable, plantigrade foot and reduce pain.

Preoperative workflow includes history and physical, informed consent addressing risks (wound complications, neurovascular injury, limb length changes), pre-op medical clearance, and templating for intraoperative stabilization (e.g., tibiocalcaneal fusion, external fixation, or custom prosthesis). On the day of service the patient is taken to the operating room under general or regional anesthesia. The surgeon performs 28130 (excision of talus/astragalus), addresses surrounding soft tissue, debrides nonviable bone, and stabilizes the ankle with the selected fixation method. Postoperative care includes inpatient monitoring as needed, pain control, antibiotics as indicated, immobilization in a cast or external fixator, and staged rehabilitation with non–weight bearing progressing per surgeon protocol.

Typical site of service: outpatient surgical center or hospital operating room. Service type: major reconstructive/orthopedic surgery under general or regional anesthesia. Typical modifiers applied depend on laterality, professional vs technical reporting, and circumstances such as increased procedural complexity or bilateral procedures.

Coding Specifications

Modifier

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

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

CPT 28175: Radical Resection of Phalanx for Tumor

CPT-28140-METATARSAL-EXCISION-SURGICAL-REMOVAL

CPT 28140: Metatarsal Excision (Partial or Complete)

CPT-28050-FOOT-JOINT-EXPLORATION-SOFT-TISSUE-BIOPSY

CPT 28050: Foot Joint Exploration with Soft Tissue Biopsy

CPT-28104-TARSAL-METATARSAL-BONE-CYST-EXCISION

CPT 28104: Excision of Bone Cyst or Benign Tumor, Tarsal/Metatarsal

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

CPT 28106: Tarsal or Metatarsal Bone Cyst Excision with Autograft

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-28116-TARSAL-COALITION-EXCISION

CPT 28116: Excision of Tarsal Coalition

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

CPT 28088: Synovectomy of Extensor Tendon Sheath, Foot

Showing 1–10 of 45

Taxonomy Code	Specialty	Notes
207X00000X	Orthopaedic Surgery	Foot and ankle reconstruction and trauma care; primary specialty performing `28130`.
2080P0005X	Podiatry	Podiatric surgeons perform complex hindfoot procedures including talectomy in selected cases.
207L00000X	Orthopedic Surgery of the Lower Extremity	Subspecialty focus for ankle and hindfoot reconstructive surgeries.
183100000X	Plastic Surgery	Consultation for soft tissue coverage or complex reconstructions when soft tissue defects are present.
208000000X	General Surgery (Trauma)	In settings of severe trauma, trauma surgeons may participate in limb-salvage procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M84.45XA`	Pathological fracture, talus, initial encounter	Pathologic talar collapse or fracture may necessitate talectomy when reconstruction is not feasible.
`S92.05XA`	Fracture of talus, initial encounter for closed fracture	Severe talar fractures with comminution can lead to talectomy if the talus is non-reconstructable.
`M19.071`	Primary osteoarthritis, right ankle and foot	End-stage arthrosis of the ankle with talar involvement can lead to talus excision and fusion procedures.
`M86.671`	Osteomyelitis, right ankle and foot	Chronic infection of the talus may require excision of the bone for eradication of infection.
`M21.6X1`	Other acquired deformities of the foot, right foot	Severe deformity associated with talar malalignment may be addressed with talectomy for correction.
`T84.84XA`	Infection and inflammatory reaction due to internal fixation device, initial encounter	Infected hardware involving the talus or adjacent constructs may result in talus removal during salvage procedures.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27702`	Open treatment of acute or chronic bimalleolar ankle fracture, with or without internal or external fixation	May be performed prior to or as part of stabilization when malunions or fractures coexist with talar pathology.
`27486`	Arthrodesis, ankle, with or without autograft or allograft (tibiotalar and tibiocalcaneal fusion)	Common adjunct or subsequent procedure to stabilize the ankle after talectomy; tibiocalcaneal fusion often performed concomitantly.
`28122`	Resection, calcaneus; partial	Performed when combined hindfoot bone resections are necessary for deformity correction or to obtain a plantigrade foot.
`20690`	Application of external fixation system (any type)	External fixation may be used intraoperatively or postoperatively to maintain alignment after talus excision.
`11043`	Debridement, muscle and/or fascia and skin (thigh, hip, buttock, etc.) — larger debridement codes used for severe soft tissue management	Used when extensive soft tissue debridement is required in conjunction with talus excision for infection or nonviable tissue.
`28899`	Unlisted procedure, ankle and foot	Use for procedures or implants specific to complex reconstructions not described by existing CPT codes; may accompany custom reconstructions after talectomy.

`RT`	Right side	Use when the procedure is performed on the right ankle/talus.
`LT`	Left side	Use when the procedure is performed on the left ankle/talus.
`50`	Bilateral procedure	Use when `28130` is performed on both taluses during the same operative session.
`62`	Two surgeons	Use when two surgeons of different specialties perform distinct portions of the procedure.
`22`	Increased procedural services	Use to report unusual procedural complexity or extended operative time beyond typical for `28130`.
`59`	Distinct procedural service	Use when a separate, distinct procedure unrelated to `28130` is performed in the same operative session.
`76`	Repeat procedure by same physician	Data not available in the input.
`78`	Return to the operating room for a related procedure during the postoperative period	Use when the patient returns to the OR for a complication or related unplanned procedure after `28130`.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Data not available in the input.
`52`	Reduced services	Use when the procedure is partially completed or abandoned for documented reasons.
`53`	Discontinued procedure	Use when the procedure is started but then discontinued due to extenuating circumstances.
`26`	Professional component	Use when reporting only the surgeon's professional service separate from technical facility charges (rare for `28130`).
`TC`	Technical component	Use when reporting only the technical component (e.g., facility charges) separate from the surgeon's professional fee.
`GC`	Service performed under a residency program by a teaching physician	Use when a teaching physician documents appropriate involvement per payer rules.

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