Summary & Overview
CPT 28309: Osteotomy of Multiple Metatarsals for Pes Cavus
CPT code 28309 represents a surgical osteotomy of multiple metatarsal bones to correct pes cavus and realign the forefoot. This code is used to document and bill for multimetatarsal corrective surgery and is clinically important because pes cavus can cause chronic pain, instability, and progressive deformity if not addressed. Proper coding ensures accurate capture of surgical complexity and resource use for inpatient and outpatient surgical settings.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national overview of how CPT code 28309 is classified and applied in surgical orthopaedics, typical sites of service, and the clinical context surrounding multimetatarsal osteotomies for pes cavus. The publication also summarizes benchmark considerations, common modifiers reported with surgical procedures, and areas where coding clarity affects coverage and claims processing.
The content provides clinicians, coding professionals, and policy analysts with a clear description of the procedure tied to this code, operational context for billing across major payers, and an outline of topics to review for documentation and reimbursement alignment. Data not available in the input is indicated where applicable.
Billing Code Overview
CPT code 28309 describes an osteotomy of multiple metatarsal bones performed to treat pes cavus and to realign metatarsal anatomy. This procedure involves surgical cutting and repositioning of two or more metatarsals to correct deformity and restore foot alignment.
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Service type: Surgical orthopaedic procedure
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Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 45-year-old patient presents to an orthopedic foot and ankle clinic with progressive forefoot pain, rigid high-arched foot deformity, and difficulty with shoe wear and ambulation. On examination there is cavovarus alignment with callosities beneath the lateral forefoot and limited subtalar motion. Weight-bearing radiographs show elevated longitudinal arch and multiple metatarsal malalignment consistent with pes cavus with deforming forces across the lesser metatarsals. Conservative care including custom orthotics, shoe modification, and targeted physical therapy failed to relieve symptoms over 3–6 months.
The surgical plan includes an osteotomy of multiple metatarsal bones (28309) to realign the forefoot and reduce pressure points. The typical workflow: preoperative evaluation and imaging in clinic; informed consent and medical optimization; procedure performed in an ambulatory surgery center or hospital operating room under general or regional anesthesia; intraoperative fluoroscopy to confirm osteotomy alignment; fixation as indicated with screws or plates; postoperative pain control, splinting or short leg cast, and early protected weight bearing per surgeon protocol; routine follow-up at 2 weeks, 6 weeks, and 3 months for wound and radiographic evaluation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
50 | Bilateral Procedure | When osteotomies are performed on metatarsals of both feet during the same operative session. |