Summary & Overview
CPT 28297: Bunion Excision with First Metatarsal–Medial Cuneiform Fusion
CPT code 28297 denotes a surgical correction of a bunion that combines removal of bony prominence with fusion of the joint between the first metatarsal and the medial cuneiform; sesamoid excision may also be included. This procedure is clinically significant because it addresses symptomatic hallux valgus with midfoot involvement and can affect postoperative function, complication profiles, and resource use across surgical settings. Nationally, the code captures a defined forefoot arthrodesis often billed for patients requiring definitive correction when joint instability or deformity extends to the tarsometatarsal articulation.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and which payer contracts commonly adjudicate such claims. The publication presents benchmarks and coding considerations relevant to billing and coverage — including utilization patterns, common modifiers (listed elsewhere), and how this service maps to surgical service lines.
This summary is intended to inform billing professionals, surgical practices, and policy analysts about the clinical scope of CPT code 28297, the payer landscape addressed in the report, and the types of operational and reimbursement questions that typically arise for forefoot arthrodesis procedures.
Billing Code Overview
CPT code 28297 describes a surgical procedure to correct a bunion deformity by removing bone from the bunion and performing an arthrodesis (fusion) of the joint between the first metatarsal and the medial cuneiform. The description notes that the procedure may include excision of the sesamoid bones beneath the first metatarsophalangeal joint.
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Service type: Surgical — reconstructive/arthrodesis procedure of the forefoot.
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Typical site of service: Hospital operating room or ambulatory surgery center; may also be performed in an outpatient surgical clinic equipped for operative foot procedures.
Clinical & Coding Specifications
Clinical Context
A 62-year-old ambulatory female presents with progressive pain and a visible medial eminence at the first metatarsophalangeal joint causing difficulty with shoe wear and forefoot ambulation. Conservative measures including wider shoes, orthotics, NSAIDs, and steroid injection provided insufficient relief over 6–12 months. Imaging confirms a large hallux valgus deformity with articular degeneration at the first tarsometatarsal–first metatarsal junction and symptomatic sesamoiditis. The orthopedic foot and ankle surgeon schedules operative correction under regional block or general anesthesia.
The intraoperative procedure includes removal of the medial eminence (bunionectomy), correction of metatarsal alignment, and fusion of the first metatarsal to the medial cuneiform (first tarsometatarsal fusion) with internal fixation. The surgeon may excise one or both sesamoid bones if they are symptomatic or obstruct correction. Typical perioperative workflow includes preoperative evaluation, imaging review, informed consent, anesthesia clearance, operative fixation, intraoperative fluoroscopy, postoperative dressing and splinting, and routine follow-up for wound check and progressive weightbearing guidance.
Typical site of service is an ambulatory surgery center or hospital outpatient department; inpatient setting is uncommon unless comorbidities require admission.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |