Summary & Overview
CPT 28200: Open Repair of Flexor Tendon of Foot
CPT code 28200 denotes open surgical repair of a torn or ruptured flexor tendon in the foot, targeting restoration of normal joint motion without use of a tendon graft. Nationally, this operative code is relevant for orthopedic and podiatric surgical services addressing traumatic or degenerative tendon injuries of the toes and hallux. The code captures a discrete reconstructive procedure used in both acute-repair settings (within 24 hours of injury) and delayed repairs.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for when the procedure is typically performed, the usual sites of service, and common billing considerations tied to surgical foot tendon repair. The publication also provides benchmarking information and policy-related notes that affect coverage and claim adjudication at a national level, as well as coding peers and related procedure groupings for billing workflows.
This summary equips clinicians, coding staff, and payers with a concise reference to the procedure’s clinical scope, expected care settings, and the payers commonly involved in reimbursement and coverage decisions.
Billing Code Overview
CPT code 28200 describes an open surgical repair of a torn or ruptured flexor tendon of the foot to restore normal joint motion. The procedure may involve repair of the flexor hallucis longus (big toe) or the flexor digitorum longus and its branches (second through fifth toes). The operation explicitly does not include obtaining or placing a tendon graft.
Service Type: Surgical — Tendon Repair (Foot)
Typical Site of Service: Hospital operating room or ambulatory surgical center, performed under appropriate anesthesia. If performed emergently, the procedure may take place within 24 hours of injury; it may also be performed at a later time depending on clinical circumstances.
Clinical & Coding Specifications
Clinical Context
A 28-year-old recreational soccer player presents to the emergency department after an acute forcible hyperflexion injury to the forefoot during a match. The patient reports immediate pain, inability to actively plantarflex the great toe and second toe, and a visible gap along the plantar aspect of the foot. Examination demonstrates tenderness and loss of active toe flexion consistent with flexor tendon injury. Radiographs exclude fracture; ultrasound confirms a laceration/rupture of the flexor hallucis longus tendon without a tendon defect requiring grafting. The surgeon schedules open primary repair of the ruptured flexor tendon (CPT 28200) in the operating room under regional or general anesthesia. Typical workflow includes preoperative evaluation and consent, surgical site marking, regional or general anesthesia administration, open exposure of the injured flexor tendon, primary tendon repair with appropriate suture technique, irrigation and layered closure, sterile dressing and immobilization (posterior splint or boot), and postoperative instructions including non–weight bearing, wound care, and hand/foot therapy referral for progressive range-of-motion and strengthening. Follow-up visits are scheduled to assess wound healing, suture removal, and staged rehabilitation. This procedure is commonly performed in the hospital outpatient department or ambulatory surgery center for subacute repairs, and in the emergency or inpatient operating room setting when performed within 24 hours of traumatic injury.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT |