CPT 28286 Resection Proximal Phalanx Reimbursement | OpenPayer

Summary & Overview

CPT 28286: Resection Proximal Phalanx for Fifth Toe Hammer Toe

CPT code 28286 covers surgical correction of a fifth-toe hammer toe by resection of the proximal phalanx with a volar plastic closure. This operative code is relevant nationally for podiatry and orthopedic practices that treat lesser toe deformities and for payers managing episodes of foot and ankle care. The code is used across major commercial plans and Medicare and informs payment, prior authorization, and bundling decisions for minor toe reconstruction procedures. Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context about the procedure, benchmarks for coding and site-of-service norms, and policy considerations that affect coverage and utilization. The summary covers coding scope, common service settings, and typical clinical intent (correction of structural toe deformity to relieve pain and improve function). Data not available in the input for associated ICD-10 diagnoses, related codes, and taxonomies is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 28286hammer toetoe resectionpodiatry surgeryambulatory surgeryoutpatient procedurelesser toe deformityvolar closure

Billing Code Overview

CPT code 28286 describes surgical correction of a hammer toe deformity of the fifth toe by resection of the proximal phalanx with a volar plastic closure. The procedure entails removing part of the proximal phalanx to correct the dorsiflexed position of the toe and closing the soft tissues on the plantar (volar) surface to restore form and function.

Service type: Surgical correction of lesser toe deformity (operative podiatric/orthopedic procedure)
Typical site of service: Ambulatory surgical center or hospital outpatient surgical setting; may also be performed in an office-based surgical suite when appropriate

Clinical & Coding Specifications

Clinical Context

A typical patient is a 55-year-old ambulatory adult presenting to a podiatric surgery clinic with progressive pain and pressure at the distal forefoot related to a flexible or rigid hammer toe deformity of the fifth toe. Conservative care — footwear modification, padding, orthotics, and corticosteroid injection — has failed to relieve focal dorsal or tip pressure and recurrent corns. The surgeon documents a symptomatic flexion deformity of the proximal interphalangeal joint with dorsal callus and limited shoe wear tolerance. After preoperative evaluation and informed consent, the patient undergoes a planned outpatient operative correction: resection of the proximal phalanx of the fifth toe with volar plastic closure to restore toe alignment and relieve pressure. The procedure is performed under local block with monitored anesthesia care or regional anesthesia in an ambulatory surgery center or hospital outpatient department. Standard perioperative workflow includes pre-op mark and timeout, sterile prep and tourniquet as indicated, intraoperative hemostasis, layered volar closure, application of dressing and postoperative shoe, and discharge with wound care and weight-bearing instructions. Typical billing includes the primary procedure code 28286; documentation should support indications, conservative treatments tried, operative details (resection length, soft tissue work, closure), anesthesia type, and laterality modifiers as applicable.

Coding Specifications

Modifier	Description	When to Use
`50`

Related Codes

CPT-28360-CLEFT-FOOT-RECONSTRUCTION

CPT 28360: Cleft Foot Reconstruction

CPT-28306-FIRST-METATARSAL-OSTEOTOMY-BUNION-CORRECTION

CPT 28306: First Metatarsal Osteotomy for Bunion Correction

CPT-28320-TARSAL-BONE-MALUNION-NONUNION-REPAIR

CPT 28320: Surgical Repair of Tarsal Bone Malunion or Nonunion

CPT-28234-EXTENSOR-TENDON-DIVISION-FOOT-TOE

CPT 28234: Extensor Tendon Division of Foot or Toe

CPT-28305-TARSAL-OSTEOTOMY-WITH-BONE-GRAFT

CPT 28305: Tarsal Osteotomy with Bone Graft for Foot Realignment

CPT-28260-TALONAVICULAR-JOINT-CAPSULE-INCISION-CLUBFOOT-CORRECTION

CPT 28260: Talonavicular Joint Capsule Incision for Clubfoot Correction

CPT-28302-TALUS-OSTEOTOMY-ANKLE-BONE-REALIGNMENT

CPT 28302: Osteotomy of Talus for Ankle Realignment

CPT-28230-FOOT-FLEXOR-TENDON-RELEASE-TENOTOMY

CPT 28230: Foot Flexor Tendon Release (Tenotomy)

CPT-28340-TOE-SOFT-TISSUE-RESECTION-RECONSTRUCTION

CPT 28340: Soft-Tissue Resection and Reconstruction of Toe

CPT-28208-EXTENSOR-TENDON-REPAIR-FOOT

CPT 28208: Extensor Tendon Repair of Foot

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Taxonomy Code	Specialty	Notes
`173B00000X`	Podiatry	Most common specialty performing digital toe corrective procedures.
`207R00000X`	Orthopedic Surgery	Foot and ankle orthopedic surgeons perform toe phalanx resections in complex cases.
`2080P0003X`	General Surgery (Foot/Ankle focused)	Some general surgeons with foot expertise may perform toe surgeries in select settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M20.4`	Hammertoe (acquired)	Direct diagnosis indicating deformity corrected by `28286`.
`M20.6`	Other deformities of toe(s)	Used for toe deformities that may include malalignment requiring surgical correction.
`L84`	Corns and callosities	Common symptomatic tissue overlying hammer toe prompting surgical correction.
`M79.67`	Pain in foot and toe	Symptom code often accompanying functional impairment from hammer toe.
`Z47.89`	Encounter for other orthopedic aftercare	Used for postoperative follow-up visits after toe surgery.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`28285`	Resection, proximal interphalangeal joint (PIP), with partial or complete excision of proximal phalanx for hammer toe (other toes)	Alternative code used for PIP joint resections of toes other than the specific technique described in `28286`; may be reported if procedure differs.
`28820`	Incision and drainage of toe, infection or abscess; simple	May be performed prior to reconstructive toe surgery if active infection requires drainage before definitive correction.
`20610`	Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., injection for pain management)	Used in preoperative conservative care for symptomatic relief; not reported same day as surgery unless separate.
`12001`	Simple repair of superficial wounds (example skin closure)	Minor adjacent soft tissue repairs or closures may accompany toe procedures; report per closure rules when appropriate.
`11055`	Paring or cutting of benign hyperkeratotic lesion (e.g., corn)	Performed in clinic prior to or in conjunction with operative management for symptomatic corns on the toe.