Summary & Overview
CPT 28289: Hallux Rigidus Correction with Cheilectomy and Capsular Release
CPT code 28289 represents a surgical correction of hallux rigidus without implant placement, combining cheilectomy, debridement, and capsular release of the first metatarsophalangeal joint. This procedure addresses pain, stiffness, and limited motion from arthritis or joint inflammation in the big toe and is commonly performed in outpatient surgical settings. Nationally, the code matters because it defines coverage, billing, and quality tracking for a common orthopaedic foot procedure that can impact surgical utilization patterns and outpatient surgical resource planning.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical indications and the typical service setting, payer coverage considerations, and benchmarking context relevant to hospitals and ambulatory surgery centers. The publication outlines how CPT code 28289 maps to clinical practice, summarizes typical billing and coding considerations, and highlights areas where payers commonly set prior authorization or medical necessity criteria.
The report offers operational benchmarks, payer policy summaries, and clinical context to inform revenue cycle, surgical services leadership, and coding teams. Data not available in the input is noted where specific payer policies, utilization rates, and associated diagnosis coding details would normally appear.
Billing Code Overview
CPT code 28289 describes a surgical procedure to correct hallux rigidus without implant placement. The operation includes a cheilectomy (removal of dorsal osteophytes or bone spurs), debridement, and capsular release of the first metatarsophalangeal joint to relieve pain, stiffness, and restricted motion caused by arthritis or inflammation of the big toe joint.
Service Type: Surgical procedure — forefoot surgery focusing on the first metatarsophalangeal joint
Typical Site of Service: Hospital outpatient department or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A 62-year-old ambulatory patient presents with progressive pain, stiffness, and limited dorsiflexion of the first metatarsophalangeal (MTP) joint consistent with symptomatic hallux rigidus refractory to conservative measures (shoe modifications, orthotics, NSAIDs, and corticosteroid injection). The surgeon documents focal dorsal osteophyte formation and advanced cartilage wear on preoperative radiographs and exam. The clinical workflow includes preoperative evaluation and informed consent in the office, pre-op clearance as needed (medical history, ECG, labs), scheduling the patient for outpatient same-day surgery at an ambulatory surgery center or hospital outpatient department, administration of regional or general anesthesia in the OR, performance of 28289 (cheilectomy with debridement and capsular release of the first MTP joint without implant), intraoperative hemostasis and wound closure, postoperative recovery in PACU with standard discharge criteria, and outpatient follow-up for wound check and progressive rehabilitation. Typical payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
50 | Bilateral Procedure | When 28289 is performed on both right and left first MTP joints during the same operative session. |