Summary & Overview
CPT 28305: Tarsal Osteotomy with Bone Graft for Foot Realignment
CPT code 28305 denotes an open osteotomy of the tarsal bones with placement of a bone graft, excluding the calcaneus and talus. This reconstructive foot surgery is used to treat talus fractures and congenital or acquired tarsal deformities such as tarsal coalition, with the goal of restoring alignment and maximizing ankle joint motion. Nationally, procedures coded with 28305 are relevant for surgical specialties managing complex hindfoot and midfoot pathology and for payers covering orthopedic reconstructive care.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical intent and service setting, common billing considerations, and coverage context relevant across major national payers. The publication summarizes typical sites of service, the procedural scope embodied by the code, and the clinical scenarios that most often justify its use. It also highlights common modifiers and payer-specific considerations where available. Data not available in the input is noted explicitly when applicable.
Billing Code Overview
CPT code 28305 describes an osteotomy of the tarsal bones in which the surgeon surgically incises or transects foot bones adjacent to the joint between the foot and the leg, realigns the bones, and places a bone graft to fill gaps and straighten the deformity. The procedure excludes the calcaneus (heel bone) and talus (ankle bone). It is performed to fixate talus fractures or to correct deformities such as a tarsal coalition and to maximize ankle joint movement.
Service type: Surgical — open reconstructive foot surgery
Typical site of service: Hospital operating room or ambulatory surgery center (inpatient or outpatient surgical setting)
Clinical & Coding Specifications
Clinical Context
A 28-year-old recreational soccer player presents with progressive lateral midfoot pain, recurrent ankle stiffness, and difficulty with push-off. Imaging (weight-bearing radiographs and CT) demonstrates symptomatic tarsal coalition of the talocalcaneal and calcaneonavicular joints with associated hindfoot valgus and limited subtalar motion. Conservative care including physical therapy, orthotics, activity modification, and a trial of corticosteroid injection has failed. The orthopedic foot and ankle surgeon schedules an operative correction: a tarsal osteotomy with realignment and placement of structural bone graft to correct the coalition and restore hindfoot and midfoot alignment.
Preoperative workflow includes: history and physical, imaging review, informed consent documenting indication and risks, anesthesia evaluation, and preop antibiotic prophylaxis. Intraoperative steps include incision over the involved tarsal segment, osteotomy/transection of the affected tarsal bone(s) (excluding talus and calcaneus per code definition), debridement of coalition, realignment of bony segments, placement of autograft or allograft to fill defects, and fixation as required. Postoperative care includes wound checks, immobilization in a cast or boot, weight-bearing restrictions, pain management, and scheduled radiographic follow-up to document fusion or healing and to guide rehabilitation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |