Summary & Overview
CPT 28202: Delayed Flexor Tendon Repair of Foot with Free Graft
CPT code 28202 represents a delayed surgical repair of a ruptured or torn tendon responsible for flexion of the foot and toes, performed using an autologous free graft obtained from another site on the same patient. This code is reported per tendon repaired and explicitly includes the graft harvest in the procedural definition. The procedure is clinically important for restoring plantar flexion and toe function after tendon injuries that cannot be repaired primarily or present late.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides national-level context for clinical use, billing considerations, and how common payers classify and reimburse this type of reconstructive foot tendon surgery.
Readers will find benchmarks and utilization patterns where available, an explanation of the clinical context for delayed tendon repair with autologous grafting, and a concise overview of common billing modifiers and reporting practices. Data not provided in the input (such as associated taxonomies, specific ICD-10 diagnoses, and payer-specific reimbursement rates) are noted as unavailable. The piece is aimed at clinicians, coding professionals, and policy analysts seeking a clear, concise reference for CPT code 28202 and its role in surgical foot tendon reconstruction.
Billing Code Overview
CPT code 28202 describes a delayed repair of a ruptured or torn tendon that enables flexion of the foot and toes using a free graft harvested from another part of the patient's body. The code is reported for each tendon repaired and includes obtaining the graft used for the reconstruction.
Service Type: Surgical tendon repair with autologous graft (delayed reconstruction)
Typical Site of Service: Hospital operating room or ambulatory surgery center, reflecting a surgical procedure that involves graft harvest and operative tendon reconstruction under appropriate anesthesia.
Clinical & Coding Specifications
Clinical Context
A 45-year-old recreational runner presents 3 weeks after an inversion injury to the ankle with progressive weakness and inability to actively plantarflex the toes. MRI confirms a delayed laceration/rupture of the flexor digitorum longus tendon with retraction. Nonoperative management failed to restore function. The orthopedic foot and ankle surgeon schedules a delayed open tendon repair using an autogenous free tendon graft harvested from the ipsilateral peroneus longus or hamstring to bridge the defect. The procedure is performed in an ambulatory surgery center under regional block with monitored anesthesia care. The operative workflow includes preoperative marking and consent, intraoperative exposure of the ruptured tendon, measurement of the gap, harvest of the autograft from a secondary site, graft preparation and tensioning, secure fixation of the graft to the distal and proximal tendon stumps, layered wound closure, and a sterile dressing and immobilization (typically a short leg cast or boot). Postoperative plans include opioid-sparing analgesia, wound checks, non–weight-bearing for several weeks, and referral to physical therapy for progressive range-of-motion and strengthening once healing permits. Documentation should clearly state the delayed nature of the repair, the specific tendon(s) repaired, the donor site used for the graft, and laterality for billing and medical record clarity.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
50 | Bilateral procedure | Use when identical tendon repairs are performed on both feet in the same operative session. |