CPT 28291 Hallux Rigidus Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 28291: Hallux Rigidus Repair with Cheilectomy and Silicone Implant

Headline: CPT code 28291 defines reconstructive surgery for hallux rigidus with cheilectomy and silicone joint implant

Lead: CPT code 28291 describes a surgical reconstruction of the first metatarsophalangeal joint for hallux rigidus that combines removal of dorsal osteophytes (cheilectomy), debridement and capsular release, and placement of a silicone implant to relieve pain, improve alignment, and restore motion.

What this code represents and why it matters: This code captures a specific surgical option for advanced first MTP joint arthritis and immobility. As joint-preserving and implant-based procedures evolve, accurate coding for combined cheilectomy, soft-tissue work, and silicone implant insertion affects clinical documentation, utilization tracking, and payment for foot and ankle reconstructive care nationwide.

Key payers covered: The analysis addresses coverage and payment patterns among major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

What readers will learn: Readers will get a concise clinical and billing overview of CPT code 28291, typical settings where the procedure is performed, and the policy and reimbursement topics relevant to implant-based first MTP joint surgery. The publication provides benchmarks and contextual clinical information to support coding accuracy, claims submission, and payer discussions.

Data gaps: Data not available in the input.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 28291hallux rigiduscheilectomysilicone implantfoot and ankle surgeryorthopedic surgerysurgical codingmetatarsophalangeal joint

Billing Code Overview

CPT code 28291 describes a surgical procedure for hallux rigidus of the first metatarsophalangeal joint that combines cheilectomy, debridement, capsular release, and placement of a silicone implant in the joint space. The operation targets immobility, pain, and dorsal osteophyte formation by removing bone spurs, excising damaged soft tissue, releasing contracted capsular structures, and inserting a silicone spacer to restore alignment and relieve stiffness.

Service Type: Surgical — orthopedic/foot and ankle reconstructive procedure

Typical Site of Service: Ambulatory surgery center or hospital operating room, performed by orthopedic foot and ankle or podiatric surgeons under surgical anesthesia.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 55-year-old active individual presenting with progressive dorsal and first metatarsophalangeal (MTP) joint pain, stiffness, and reduced range of motion consistent with advanced hallux rigidus. Conservative measures — orthotics, activity modification, nonsteroidal anti-inflammatory drugs, and steroid injection — have failed to relieve pain and restore function. Imaging (weight-bearing radiographs) demonstrates osteophyte formation, dorsal joint narrowing, and degenerative changes of the first MTP joint.

Preoperative workflow includes history and physical, assessment of medical comorbidities, surgical consent discussing risks/benefits, and preoperative anesthesia evaluation. In the operating room under regional or general anesthesia, the surgeon performs a dorsal cheilectomy to remove dorsal osteophytes and debrides damaged capsular and synovial tissue. A silicone interpositional implant is sized and placed into the first MTP joint to preserve motion and relieve pain. Postoperative care includes wound care, protected weight bearing in a surgical shoe or boot, pain control, and outpatient follow-up for range-of-motion and implant assessment. Typical site of service is an ambulatory surgery center or hospital outpatient department. The service type is operative surgical implantation with adjunctive debridement/cheilectomy.

Coding Specifications

Modifier	Description	When to Use
`LT`	Left side	When the procedure is performed on the left great toe.

CPT 28308: Metatarsal Osteotomy (Non‑First Metatarsal)

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

CPT 28230: Foot Flexor Tendon Release (Tenotomy)

CPT-28226-TENOLYSIS-EXTENSOR-TENDONS-FOOT

CPT 28226: Tenolysis of Extensor Tendons of Foot

CPT-28307-FIRST-METATARSAL-OSTEOTOMY-WITH-AUTOGRAFT

CPT 28307: First Metatarsal Osteotomy with Autogenous Bone Graft

CPT-28299-BUNION-DOUBLE-OSTEOTOMY-FOOT

CPT 28299: Bunion Correction with Double Osteotomy

CPT-28232-TOE-FLEXOR-TENDON-OPEN-INCISION

CPT 28232: Open Incision of Single Toe Flexor Tendon

CPT-28315-FIRST-TOE-SESAMOID-EXCISION

CPT 28315: Excision of Sesamoid Bone, First Toe

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

CPT 28305: Tarsal Osteotomy with Bone Graft for Foot Realignment

CPT-28313-TOE-ANGULAR-DEFORMITY-SOFT-TISSUE-RELEASE-TENDON-TRANSFER

CPT 28313: Surgical Correction of Toe Angular Deformity

CPT-28225-EXTENSOR-TENDON-ADHESION-RELEASE-FOOT

CPT 28225: Extensor Tendon Adhesion Release, Foot

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Taxonomy Code	Specialty	Notes
208K00000X	Podiatry	Podiatric surgeons commonly perform first MTP joint cheilectomy with implant placement.
207L00000X	Orthopedic Surgery	Foot and ankle orthopedic surgeons perform joint-preserving procedures and implant placement.
207P00000X	Orthopedic Surgery Subspecialty (Foot and Ankle)	Surgeons with foot and ankle focus managing complex hallux rigidus.
2080P0017X	Podiatric Surgery, Rearfoot/Ankle	Podiatric surgeons with surgical subspecialty often perform this procedure.
207Xi0019X	Orthopedic Surgery, Reconstructive	Reconstructive foot specialists involved in implant and joint reconstruction.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M20.12`	Hallux rigidus, right foot	Primary degenerative condition of the first MTP joint leading to pain and immobility; common indication for cheilectomy and implant.
`M20.11`	Hallux rigidus, left foot	Same as above for the left foot.
`M20.2`	Hallux valgus (acquired), not elsewhere classified	May coexist with degenerative MTP pathology and can influence surgical planning.
`M19.071`	Primary osteoarthritis, right ankle and foot	Osteoarthritic changes contributing to first MTP joint degeneration.
`M19.072`	Primary osteoarthritis, left ankle and foot	Same as above for the left side.
`M67.8`	Other synovium and tendon disorders, unspecified site	Synovial or capsular pathology addressed during debridement.
`M25.271`	Pain in right ankle and joints of right foot	Symptom code used to support medical necessity when specific diagnosis is under evaluation.
`M25.272`	Pain in left ankle and joints of left foot	Symptom code for the left-sided presentation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`28285`	Cheilectomy, first metatarsophalangeal joint; with or without sesamoidectomy	Cheilectomy alone may be performed when minimal cartilage loss exists; often performed as the debridement portion preceding implant placement.
`28292`	Arthroplasty, interpositional, first metatarsophalangeal joint; with implant (autograft/allograft)	Alternative joint-preserving arthroplasty techniques; may be used when different implant types or grafts are chosen instead of silicone implant.
`28298`	Arthrodesis; first metatarsophalangeal joint	Fusion of the first MTP joint is a definitive alternative when joint-sparing arthroplasty is not suitable.
`20680`	Removal of implant; deep (requiring incision)	Potential follow-up procedure if implant requires removal for infection, loosening, or pain.
`28820`	Amputation, toe; forefoot, metatarsal disarticulation, first toe	Reserved for severe, refractory cases with nonviable tissue or infection; not typical but related in end-stage failure scenarios.

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