Summary & Overview
CPT 28285: Hammertoe Repair, Surgical Correction
CPT code 28285 denotes surgical repair of a hammertoe deformity, a common podiatric procedure to correct a toe that remains permanently bent downward and often causes pain and functional limitation. This code matters nationally because hammertoe surgeries are frequently performed in ambulatory surgical settings and influence surgical utilization, payer coverage policies, and resource allocation for foot and ankle care. Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, the typical service setting, and what to expect in a policy and billing review: commonly observed documentation elements, how payers approach surgical foot procedures, and benchmarks for utilization and coding practice. The publication outlines benchmarking metrics, common claims considerations, and recent policy themes affecting outpatient surgical authorization and coverage for corrective toe procedures. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 28285 describes a surgical repair of a hammertoe deformity, a painful condition in which the toe remains permanently bent in a downward position. The procedure addresses the deformity by correcting soft tissue and/or bony alignment to relieve pain and restore toe position and function.
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Service type: Surgical correction of hammertoe deformity
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Typical site of service: Ambulatory surgery center or hospital outpatient department (surgical setting for podiatric/orthopedic foot procedures)
Data not available in the input for payers, associated taxonomies, and ICD-10 diagnoses.
Clinical & Coding Specifications
Clinical Context
A 62-year-old ambulatory patient presents to a podiatric surgical clinic with chronic pain and pressure at the second toe of the right foot. Conservative care including toe splinting, shoe modification, activity modification, and cortisone injection over six months provided insufficient relief. On exam the second toe demonstrates a fixed plantar-flexed deformity at the proximal interphalangeal joint with callus formation and pain on ambulation. The provider schedules operative correction under regional or local anesthesia with monitored sedation.
The clinical workflow includes preoperative evaluation and informed consent, preoperative medical clearance as needed, marking and time-out in the ambulatory surgery center or hospital outpatient setting, performance of 28285 (repair of hammertoe deformity) — which may include tendon lengthening, joint resection, or arthroplasty — intraoperative hemostasis and dressing, postoperative pain control and immobilization (buddy taping or short postoperative shoe), and routine follow-up for wound check and progressive weight bearing and range-of-motion therapy as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
50 | Bilateral Procedure | When both feet or bilateral toes are corrected in the same operative session and payer allows bilateral reporting. |