CPT 28306 First Metatarsal Osteotomy Reimbursement | OpenPayer

Summary & Overview

CPT 28306: First Metatarsal Osteotomy for Bunion Correction

CPT code 28306 designates a first metatarsal osteotomy performed to correct hallux valgus (bunion) by realigning the metatarsal and toe, and may include lengthening, shortening, or correction of angular deformities. This surgical code is commonly used in orthopedic and podiatric surgical billing for definitive operative correction of symptomatic bunions and is relevant to hospital and ambulatory surgery center workflows.

Key payers addressed in national practice and reimbursement discussions include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical intent and typical service settings, common modifier patterns and billing considerations, and contextual benchmarks where available. The publication highlights how CPT code 28306 fits into surgical care pathways for foot deformity correction, expected sites of service, and payer coverage scope. It also summarizes common documentation elements and coding nuances that affect claim adjudication and audit risk.

This summary is intended for healthcare administrators, coding professionals, and surgical providers seeking a national perspective on billing and policy context for CPT code 28306. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCignaUnitedHealthcareMedicareCPT 28306first metatarsal osteotomybunion correctionorthopedic surgerypodiatryambulatory surgerysurgical billingprocedure coding

Billing Code Overview

CPT code 28306 describes an osteotomy of the first metatarsal performed to remove a bunion and realign the first metatarsal and toe. The procedure may include lengthening, shortening, or angular correction of the first metatarsal as needed to restore alignment and relieve symptomatic hallux valgus.

Service type: Surgical procedure — foot/orthopedic surgery

Typical site of service: Hospital operating room or ambulatory surgery center (outpatient surgical setting)

Clinical & Coding Specifications

Clinical Context

A 58-year-old female presents to a podiatric surgical clinic with progressive pain and deformity of the right great toe consistent with symptomatic hallux valgus (bunion). Conservative care including widened footwear, orthotics, and NSAIDs failed to control pain and impairment of ambulation. Physical exam shows a painful medial eminence and lateral deviation of the proximal phalanx with an increased intermetatarsal angle. Radiographs confirm a moderate first metatarsal angular deformity without arthritic collapse. The surgical plan is an open first metatarsal osteotomy (bunionectomy and realignment) with fixation under regional or general anesthesia.

Typical clinical workflow: preoperative evaluation in the clinic with informed consent and surgical planning, preoperative anesthesia assessment, operative procedure in an ambulatory surgery center or hospital operating room, postoperative recovery in PACU with analgesia and dressing/boot application, and routine postoperative follow-up visits for wound check, suture removal, and graduated weightbearing and physical therapy as indicated.

Typical site of service: ambulatory surgery center or hospital outpatient surgery department for elective foot reconstructive surgery.

Service type: operative musculoskeletal procedure (first metatarsal osteotomy / bunion correction) intended to realign the first ray and correct angular deformity.

Coding Specifications

Modifier	Description	When to Use
`AA`

CPT 28280: Syndactylization of Toes for Flail Toe Correction

CPT-28202-DELAYED-TENDON-REPAIR-WITH-FREE-GRAFT

CPT 28202: Delayed Flexor Tendon Repair of Foot with Free Graft

CPT-28222-FLEXOR-TENDON-ADHESION-RELEASE-FOOT

CPT 28222: Flexor Tendon Adhesion Release, Foot

CPT-28313-TOE-ANGULAR-DEFORMITY-SOFT-TISSUE-RELEASE-TENDON-TRANSFER

CPT 28313: Surgical Correction of Toe Angular Deformity

CPT-28360-CLEFT-FOOT-RECONSTRUCTION

CPT 28360: Cleft Foot Reconstruction

CPT-28304-TARSAL-OSTEOTOMY-FOOT-BONE-REALIGNMENT

CPT 28304: Tarsal Osteotomy for Foot Bone Realignment

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

CPT 28307: First Metatarsal Osteotomy with Autogenous Bone Graft

CPT-28262-CLUBFOOT-REPAIR-TENDON-LENGTHENING-TALOTIBIAL-CAPSULE-INCISION

CPT 28262: Reconstructive Clubfoot Repair with Tendon Lengthening

CPT-28260-TALONAVICULAR-JOINT-CAPSULE-INCISION-CLUBFOOT-CORRECTION

CPT 28260: Talonavicular Joint Capsule Incision for Clubfoot Correction

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

CPT 28308: Metatarsal Osteotomy (Non‑First Metatarsal)

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Taxonomy Code	Specialty	Notes
`207P00000X`	Podiatry	Podiatric surgeons commonly perform first metatarsal osteotomies for hallux valgus correction.
`207L00000X`	Orthopedic Surgery	Foot and ankle orthopedic surgeons perform metatarsal osteotomies as part of reconstructive foot surgery.
`2080P0005X`	General Surgery (Podiatric emphasis)	Surgical specialists with foot surgery practice may perform this procedure; primarily podiatry and orthopedics perform the procedure.
`207K00000X`	Hand Surgery (not typical)	Listed for completeness; rarely involved unless multi-limb reconstruction is required.
`2080S0004X`	Orthopedic Surgery, Foot and Ankle	Subspecialty taxonomy for foot and ankle orthopedic surgeons performing complex reconstructive osteotomies.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M20.1`	Hallux valgus (acquired)	Primary indication for first metatarsal osteotomy to correct bunion deformity and relieve pain.
`M20.2`	Hallux rigidus	May coexist with bunion deformity; requires assessment if joint-sparing osteotomy is appropriate.
`M21.60`	Acquired deformity, unspecified foot	Used when a more specific hallux deformity code is not applicable; indicates foot deformity that may require osteotomy.
`M77.41`	Peroneal tendinitis, right leg	Tendinopathy of adjacent structures can contribute to forefoot pain and may be addressed in the perioperative plan.
`M79.671`	Pain in right ankle and joints of right foot	Symptom code that documents pain prompting surgical correction when associated with structural deformity.
`M21.70`	Acquired deformity, unspecified lower limb	Broader code for acquired deformities that may include metatarsal malalignment requiring osteotomy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`28820`	Capsulotomy; toe (other than great toe)	May be performed for contracture release on lesser toes during multi-toe correction procedures when concomitant surgical correction is required.
`28296`	Correction, hallux valgus (bunionette), with metatarsal osteotomy	Performed when correction involves the fifth metatarsal (bunionette) in addition to first metatarsal correction during the same operative session.
`28800`	Arthroplasty, interphalangeal plantar plate; great toe	May be used for adjacent joint procedures if hallux rigidus or joint arthropathy is addressed in the same surgical episode.
`20550`	Injection(s); single tendon sheath, or ligament, aponeurosis	May be used preoperatively or postoperatively for diagnostic or therapeutic injections in the foot related to pain management.
`11056`	Debridement of nail(s) for fungus/onycholysis	May be performed concurrently if nail pathology requires treatment during the same operative setting.

Note: If additional related procedures are performed during the same operative session, report appropriate CPT codes in accordance with payer rules and apply modifiers as indicated.

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