Summary & Overview
CPT 28295: Bunion Correction with Proximal Metatarsal Osteotomy
CPT code 28295 represents surgical correction of a bunion (hallux valgus) involving removal of bone and a proximal metatarsal osteotomy, and may include sesamoidectomy. This procedure is a common forefoot reconstructive operation and is clinically significant for correcting deformity, relieving pain, and restoring function. Nationally, billing for bunion procedures has implications for surgical workload, facility utilization, and post-operative care pathways.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical service and typical settings where the procedure is performed, plus what to expect in benchmarking and policy contexts. The publication summarizes common modifiers and coding considerations provided in the input, highlights typical sites of service (ambulatory surgical center and hospital operating rooms), and notes where input data is unavailable.
The document does not provide clinical recommendations but offers context about the code's use, common billing modifiers supplied in the input, and where additional documentation or payer-specific policy review may be needed. Data not available in the input is identified so readers know which elements require supplementary sources for payer-specific claim adjudication or diagnosis mapping.
Billing Code Overview
CPT code 28295 describes surgical correction of a bunion (hallux valgus) by removing bone and performing a proximal metatarsal osteotomy to realign the first metatarsal. The procedure may include removal of the sesamoid bones beneath the first metatarsophalangeal joint.
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Service type: Surgical foot procedure (forefoot reconstructive surgery)
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Typical site of service: Ambulatory surgical center or hospital outpatient/inpatient operating room, depending on clinical complexity and anesthesia needs.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 55-year-old ambulatory adult presenting with progressive medial prominence at the first metatarsophalangeal (MTP) joint, pain with shoe wear, and functional limitation despite conservative care (orthotics, NSAIDs, activity modification). Clinical exam demonstrates hallux valgus deformity with lateral deviation of the great toe and first metatarsal prominence; radiographs confirm an increased intermetatarsal angle and hallux valgus angle appropriate for proximal metatarsal osteotomy. The provider schedules an operative intervention: bunionectomy with proximal metatarsal osteotomy, with possible sesamoidectomy if indicated. The typical workflow includes preoperative evaluation (history, focused foot exam, weight-bearing radiographs), informed consent documenting the planned 28295 procedure, pre-op medical clearance as needed, performance of the osteotomy and realignment in an ambulatory surgery center or hospital operating room under regional or general anesthesia, intraoperative fluoroscopic confirmation of correction, possible excision of hypertrophic medial eminence and sesamoids, and postoperative immobilization with ceramic or plaster boot and planned follow-up at 2 weeks, 6 weeks, and 12 weeks for radiographic healing and progressive weight bearing. Typical sites of service are the ambulatory surgery center (ASC) or hospital outpatient operating room. Common patient comorbidities affecting planning include diabetes mellitus, peripheral vascular disease, and smoking history, which may alter healing expectations and postoperative management.
Coding Specifications
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