CPT 28292 Bunionectomy Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 28292: Bunionectomy with Possible Sesamoidectomy

CPT code 28292 denotes surgical excision of bone from a bunion (hallux valgus) and may include removal of the sesamoid bones beneath the first metatarsophalangeal joint. This procedure is a common foot and ankle operation addressing pain, deformity, and impaired function; it is relevant nationally due to its frequency in orthopedic and podiatric practices and its implications for surgical scheduling, supply use, and anesthetic care. Key payers considered in discussions of utilization and payment practice include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will gain a concise clinical and billing profile of CPT code 28292, including the typical service setting, common clinical indications, and the types of benchmarks and policy topics commonly linked to procedural foot surgery (coverage criteria, site-of-service considerations, and payer-specific prior authorization practices). The summary provides context for how this code is used in ambulatory surgery centers versus inpatient settings, what factors influence coding and billing decisions, and which metrics and policy updates are most relevant for clinicians, billing professionals, and payers. Data not available in the input is noted where applicable.

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Billing Code Overview

CPT code 28292 describes surgical removal of bone from a bunion, a deformity at the first metatarsophalangeal joint that produces a bony prominence near the base of the big toe. The procedure may include excision of the sesamoid bones when clinically indicated.

Service type: Surgical procedure — bunionectomy with possible sesamoidectomy
Typical site of service: Outpatient ambulatory surgery center or inpatient hospital operating room, depending on clinical complexity and patient factors

Clinical & Coding Specifications

Clinical Context

A 56-year-old ambulatory female presents to a podiatric surgery clinic with progressive medial prominence at the first metatarsophalangeal (MTP) joint, pain with shoe wear, and callus formation. Conservative measures including shoe modification, orthotics, and NSAIDs have failed. Examination shows a hallux valgus deformity with lateral deviation of the hallux and a palpable bony prominence over the first MTP joint. Preoperative weight-bearing radiographs confirm mild-to-moderate hallux valgus without severe arthritic joint space loss.

The patient is scheduled for an operative bunionectomy with exostectomy (removal of the dorsal/medial bony prominence) and possible sesamoid bone debridement under regional or general anesthesia. Typical workflow: preoperative evaluation and informed consent in clinic, pre-op anesthesia evaluation, procedure performed in an ambulatory surgery center or hospital outpatient department, postoperative recovery with discharge instructions for weight-bearing status and follow-up wound checks in clinic. Intraoperative documentation includes laterality, specific bones removed (metatarsal exostectomy and any sesamoid excision), anesthesia type, estimated blood loss, complications, and implants if used. Postoperative coding is based on the primary procedure 28292, with appropriate modifiers for laterality, multiple procedures, professional vs technical component, or unusual circumstances documented.

Coding Specifications

Modifier	Description	When to Use
`50`

CPT 28200: Open Repair of Flexor Tendon of Foot

CPT-28308-METATARSAL-OSTEOTOMY-NON-FIRST-TOE

CPT 28308: Metatarsal Osteotomy (Non‑First Metatarsal)

CPT-28280-TOE-SYNDACTYLIZATION-RECONSTRUCTIVE-FOOT-SURGERY

CPT 28280: Syndactylization of Toes for Flail Toe Correction

CPT-28309-MULTIPLE-METATARSAL-OSTEOTOMY-PES-CAVUS

CPT 28309: Osteotomy of Multiple Metatarsals for Pes Cavus

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

CPT 28307: First Metatarsal Osteotomy with Autogenous Bone Graft

CPT-28296-BUNION-DISTAL-METATARSAL-OSTEOTOMY

CPT 28296: Bunion Correction with Distal Metatarsal Osteotomy

CPT-28322-METATARSAL-REPAIR-WITH-BONE-GRAFT-MALUNION-NONUNION

CPT 28322: Metatarsal Repair with Bone Graft for Malunion/Nonunion

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

CPT 28232: Open Incision of Single Toe Flexor Tendon

CPT-28208-EXTENSOR-TENDON-REPAIR-FOOT

CPT 28208: Extensor Tendon Repair of Foot

CPT-28300-CALCANEAL-OSTEOTOMY-HEEL-BONE-REALIGNMENT

CPT 28300: Calcaneal Osteotomy for Heel Bone Realignment

Showing 1–10 of 50

Taxonomy Code	Specialty	Notes
207PS0012X	Podiatry	Podiatric surgeons commonly perform `28292` in ambulatory surgery centers and office-based surgical settings.
2080P0206X	Orthopedic Surgery	Foot and ankle orthopedic surgeons perform first MTP exostectomies, often when combined with osteotomies.
207X00000X	General Surgery / Surgical Foot Specialist	Surgeons with foot specialization may bill for forefoot procedures; used less commonly than podiatry or orthopedics.
363L00000X	Pain Medicine (support)	Anesthesia and perioperative pain specialists involved in regional blocks for the procedure.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M20.1`	Hallux valgus (acquired)	Primary diagnosis for bunion deformity; indicates indication for exostectomy when symptomatic.
`M20.11`	Hallux valgus (acquired), right foot	Side-specific code used when documenting laterality for operative planning and billing.
`M20.12`	Hallux valgus (acquired), left foot	Side-specific code used when documenting laterality for operative planning and billing.
`M21.6`	Hallux rigidus (hallux limitus)	When degenerative changes at the first MTP contribute to symptoms; may alter surgical approach.
`M79.67`	Pain in right lower limb	Used for symptom coding when documentation focuses on pain presentation; pair with specific hallux code.
`M79.66`	Pain in left lower limb	Used for symptom coding when documentation focuses on pain presentation; pair with specific hallux code.
`L84`	Corns and callosities	Associated skin changes from bunion prominence; often present and addressed in pre/postoperative care.

If no ICD-10 codes were provided in the input, the above list reflects commonly reported diagnoses for a patient undergoing 28292.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`28285`	Bunionectomy, cheilectomy, and phalangeal osteotomy; distal or proximal	May be performed when an osteotomy of the proximal phalanx or metatarsal is required in addition to exostectomy for deformity correction.
`28300`	Excision, bunionette (tailor's bunion)	Related forefoot excision procedure for a fifth metatarsal prominence; sometimes concurrently addressed if symptomatic.
`28615`	Reduction, dislocation; metatarsophalangeal (any)	Performed if intraoperative reduction of MTP joint is required in setting of severe deformity or instability.
`28820`	Repair, tendon, flexor or extensor; foot, primary or secondary	May be billed if concurrent tendon repair is performed during the same operative session.
`66200`	Excision of foreign body, foot (listed for example of additional foot procedures)	Can be performed if foreign body or sesamoid fragments are removed in addition to the exostectomy.

Note: If no related CPT codes were provided in the input, the above list reflects commonly associated procedures performed before, during, or after a bunion exostectomy. Documentation must support each additional code and appropriate modifier use for multiple or distinct procedures.

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