Summary & Overview
CPT 28298: Bunion Correction with Proximal Phalanx Osteotomy
CPT code 28298 represents surgical correction of a bunion that involves bone removal at the big-toe joint and a proximal phalanx osteotomy to realign the toe; the procedure can include excision of the sesamoid bones. This code is important nationally because bunion surgery is a common elective orthopedic procedure with implications for surgical resource use, payer coverage policies, and patient access to ambulatory surgical settings. Key payers covered in this 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 a summary of what to expect in payer coverage and billing practice. The publication outlines common billing modifiers, expected service line placement, and areas where policy updates or payer-specific edits frequently occur. It also provides benchmarking guidance, coding tips for accurately reflecting the surgical components, and references to related procedures and potential documentation needs. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 28298 describes surgical correction of a bunion deformity involving removal of bone from the metatarsophalangeal region and a proximal phalanx osteotomy to cut and realign the toe bone. The procedure may also include removal of the sesamoid bones beneath the big toe joint.
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Service type: Surgical orthopedic procedure for forefoot/bunion correction
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Typical site of service: Ambulatory surgery center or hospital outpatient surgical unit; may also occur in an inpatient setting when clinically indicated
Clinical & Coding Specifications
Clinical Context
A 56-year-old ambulatory female presents to an outpatient orthopedic surgery clinic with progressive medial deviation of the first metatarsophalangeal joint, painful hallux valgus deformity limiting shoe wear and activities. After failed conservative care (shoe modification, orthoses, NSAIDs), the orthopedic foot and ankle surgeon schedules operative correction. In the operating room under regional or general anesthesia, the surgeon performs a bunionectomy with removal of the medial eminence, a proximal phalanx osteotomy to realign the hallux, and selective sesamoid excision if adherent or pathologic. Typical workflow includes preoperative evaluation, intraoperative imaging to confirm alignment, osteotomy and fixation as indicated, wound closure, postoperative immobilization (dressing and cast or boot), and scheduled follow-up for suture removal and weight-bearing progression.
Typical site of service: ambulatory surgery center or hospital outpatient surgical department.
Service type: operative musculoskeletal procedure — foot reconstructive surgery (bunionectomy with proximal phalanx osteotomy, ± sesamoidectomy).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
51 | Multiple procedures | When additional distinct procedures are billed on the same day along with the primary procedure. |