CPT 28173 Radical Metatarsal Resection Reimbursement | OpenPayer

Summary & Overview

CPT 28173: Radical Resection of Metatarsal for Tumor

CPT code 28173 denotes a radical surgical resection of a metatarsal bone and adjacent tissue to remove a tumor, typically performed for malignant or aggressive benign lesions requiring wide excision. This code is used to document substantial forefoot oncologic surgery and has implications for surgical planning, site-of-service decisions, and payer coverage determinations nationwide. Key national payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will gain a concise clinical and billing overview of the procedure, understand which payers are commonly relevant for claims involving this code, and find a summary of the clinical context in which the code is used. The publication covers benchmarks where available, common billing considerations, and recent policy or coverage issues that affect authorization and reimbursement practices. It also outlines typical settings where the procedure is performed and the general clinical rationale for radical resection in metatarsal tumors. Data not available in the input for specific payer rates, associated taxonomies, and ICD-10 pairings is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare28173CPTmetatarsal resectionorthopedic oncologyforefoot surgerysurgical procedureambulatory surgeryhospital outpatient

Billing Code Overview

CPT code 28173 describes a radical resection of a metatarsal bone performed to remove a tumor. The procedure involves surgical removal of the affected metatarsal and surrounding soft tissue, often with a wide margin of normal tissue excised when the lesion is malignant, to reduce the risk of residual tumor.

Service type: Surgical oncology / orthopedic oncology procedure

Typical site of service: Hospital operating room or ambulatory surgery center, depending on the case complexity and need for inpatient care.

Clinical & Coding Specifications

Clinical Context

A 58-year-old male presents with a painful, enlarging mass over the dorsal aspect of the forefoot centered at the second metatarsal. Imaging with foot radiographs and MRI demonstrates an aggressive lesion involving the second metatarsal with cortical destruction and soft-tissue extension. Core needle biopsy returns a diagnosis of osteosarcoma of the metatarsal. The orthopedic foot and ankle oncology surgeon schedules the patient for a radical metatarsal resection with wide margins to achieve local tumor control. The typical clinical workflow includes preoperative oncology consultation, staging imaging (chest CT to rule out pulmonary metastases), preoperative anesthesia evaluation, informed consent for limb-sparing resection versus possible amputation, intraoperative pathologic margin assessment as available, the surgical resection of the affected metatarsal and adjacent soft tissue, reconstruction or soft-tissue coverage as indicated, and postoperative admission for pain control, wound monitoring, and coordination with medical oncology for adjuvant therapy planning.

Coding Specifications

Modifier	Description	When to Use
`11`	Normal procedure when performed for a surgical service	Use when the service is performed as the primary procedure without unusual circumstances.
`22`

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

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

CPT 28126: Partial Resection of Infected Toe Bone

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

CPT 28055: Bursal Excision with Nerve Dissection/Neurectomy

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

CPT 28054: Surgical Biopsy of Toe or Finger Joint

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

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

CPT-28150-TOE-PHALANX-EXCISION

CPT 28150: Excision of One Toe Phalanx

CPT-28118-CALCANEUS-EXCISION-HEEL-BONE-RESECTION

CPT 28118: Excision of Calcaneus for Infection or Necrosis

CPT-28113-FIFTH-METATARSAL-HEAD-EXCISION-NECROSIS-INFECTION

CPT 28113: Excision of Fifth Metatarsal Head for Necrosis or Infection

CPT-28062-PLANTAR-FASCIA-RELEASE-PLANTAR-FASCIOTOMY

CPT 28062: Plantar Fascia Removal to Relieve Tension

CPT-28103-TALUS-CALCANEUS-BONE-CYST-ALLOGRAFT-EXCISION

CPT 28103: Excision of Talus/Calcaneus Bone Cyst with Allograft

Showing 1–10 of 45

Taxonomy Code	Specialty	Notes
`207X00000X`	Orthopaedic Surgery	Foot and ankle or oncology-focused orthopedists commonly perform metatarsal tumor resections.
`207K00000X`	Orthopaedic Foot and Ankle Surgery	Specialists in foot and ankle reconstructive surgery involved in resection and reconstruction.
`2080P0006X`	Surgical Oncology	Surgical oncologists performing limb-sparing tumor resections and margin assessment.
`208000000X`	General Surgery	General surgeons with oncologic expertise may participate in soft-tissue tumor resections when needed.
`207L00000X`	Plastic and Reconstructive Surgery	Plastic surgeons provide local flap or soft-tissue coverage and reconstruction after wide resection.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C40.2`	Malignant neoplasm of tibia and fibula	Not directly metatarsal but representative of malignant osseous tumors of the lower extremity; included here as Data not available in the input.
`C49.3`	Malignant neoplasm of peripheral nerves and autonomic nervous system of lower limb, including hip	Soft-tissue sarcoma codes relevant when tumor arises from peri-metatarsal soft tissues.
`M86.9`	Osteomyelitis, unspecified	Chronic osteomyelitis can necessitate resection of infected metatarsal bone in addition to or instead of tumor resection.
`D16.4`	Benign neoplasm of bone of lower limb, including hip	Benign bone tumors of the metatarsal (osteochondroma, enchondroma) occasionally require resection.
`S92.9`	Fracture of foot, unspecified	Pathologic fracture through a neoplastic lesion may precipitate surgical resection of the affected metatarsal.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11042`	Debridement, subcutaneous tissue (including epidermis and dermis, if performed); first 20 sq cm or less	May be used for debridement of soft-tissue involved with the tumor or infected wound prior to or during reconstruction.
`19318`	Partial foot amputation (metatarsal level) — Note: CPT `19318` is not a standard code for foot; Data not available in the input.	Data not available in the input.
`27607`	Amputation, foot; transmetatarsal, with or without toe amputation, primary closure	Performed when limb-sparing resection is not feasible and a more distal amputation is required instead of isolated metatarsal resection.
`88307`	Surgical pathology, gross and microscopic examination, tissue; complex evaluation	Used for pathology examination of the resected metatarsal specimen and margin assessment.
`73630`	Radiologic examination, foot; complete, 3 views	Preoperative imaging and postoperative follow-up radiographs often performed during staging and monitoring.

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