CPT 28322 Metatarsal Repair Reimbursement | OpenPayer

Summary & Overview

CPT 28322: Metatarsal Repair with Bone Graft for Malunion/Nonunion

CPT code 28322 represents surgical repair of fractured metatarsal bones with placement of a bone graft to correct malunion or nonunion. This procedure is clinically important because untreated malunions or nonunions can cause persistent pain, deformity, and loss of foot function; bone grafting is used to promote healing and restore alignment. Nationally, this code captures complex reconstructive foot surgery that affects orthopedic care pathways and surgical resource utilization. Key payers examined include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare.

Readers will learn the clinical context for CPT code 28322, where and why the procedure is performed, and the common billing and administrative considerations tied to reconstructive metatarsal surgery. The publication provides benchmarks and policy-relevant information including typical sites of service (ambulatory surgical centers and hospitals), typical service lines (orthopedic surgery and reconstructive foot surgery), and payer coverage patterns. Data not available in the input is noted where applicable. The content is organized to assist administrators, coders, and policy analysts in understanding the code’s scope, clinical indications, and the payer landscape for national-level planning and reimbursement reference.

AetnaBlue Cross Blue ShieldCignaUnitedHealthcareMedicareCPT 28322metatarsal repairbone graftingorthopedic surgerymalunionnonunionfoot surgeryambulatory surgeryhospital surgery

Billing Code Overview

CPT code 28322 describes a surgical repair of fractured metatarsal bones that includes placement of a bone graft to address malunion (healed in incorrect position) or nonunion (failure to rejoin). The procedure is performed to restore foot function and relieve pain when a metatarsal fracture has not healed properly due to poor blood supply, infection, or other complications.

Service type: Surgical orthopedic repair with bone grafting
Typical site of service: Ambulatory surgical center or inpatient hospital setting, depending on complexity and patient needs

Clinical & Coding Specifications

Clinical Context

A 48-year-old recreational athlete presents with chronic forefoot pain and impaired ambulation six months after a midshaft fracture of the second metatarsal treated nonoperatively. Radiographs and CT demonstrate a symptomatic malunion with angular deformity and shortened metatarsal causing transfer metatarsalgia and limited push-off. The orthopedic foot and ankle surgeon plans an operative corrective osteotomy with placement of an autograft/allograft bone graft to restore length and alignment and to relieve pain and improve function.

Preoperative workflow includes history and physical, informed consent discussing risks (infection, nonunion, neurovascular injury), preop imaging (weight-bearing radiographs, CT if needed), and medical clearance. Intraoperative steps include exposure of the malunited segment, osteotomy or debridement of nonunion, bone graft placement, fixation with plate/screws or intramedullary device, and irrigation. Postoperative care includes immobilization, elevation, pain control, wound checks, progressive weight-bearing protocol, and radiographic follow-up to document healing and graft incorporation.

Coding Specifications

Modifier	Description	When to Use
`00`	Service not covered by payer policy	Rarely used; appended only when payer-specific non-covered status is required by billing rules

CPT 28307: First Metatarsal Osteotomy with Autogenous Bone Graft

CPT-28292-BUNIONECTOMY-SESAMOIDECTOMY

CPT 28292: Bunionectomy with Possible Sesamoidectomy

CPT-28306-FIRST-METATARSAL-OSTEOTOMY-BUNION-CORRECTION

CPT 28306: First Metatarsal Osteotomy for Bunion Correction

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

CPT 28308: Metatarsal Osteotomy (Non‑First Metatarsal)

CPT-28310-PROXIMAL-PHALANX-FIRST-TOE-OSTEOTOMY

CPT 28310: Osteotomy of Proximal Phalanx of First Toe

CPT-28344-POLYDACTYLY-TOE-EXCISION-REPAIR

CPT 28344: Excision of Supernumerary Toe(s) with Repair

CPT-28288-METATARSAL-HEAD-EXCISION-CONDYLECTOMY-EXOSTECTOMY

CPT 28288: Excision of Part of Single Metatarsal Head (Condylectomy/Exostectomy)

CPT-28360-CLEFT-FOOT-RECONSTRUCTION

CPT 28360: Cleft Foot Reconstruction

CPT-28240-ABDUCTOR-HALLUCIS-TENDON-RELEASE-LENGTHENING

CPT 28240: Abductor Hallucis Tendon Release/Lengthening

CPT-28309-MULTIPLE-METATARSAL-OSTEOTOMY-PES-CAVUS

CPT 28309: Osteotomy of Multiple Metatarsals for Pes Cavus

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Taxonomy Code	Specialty	Notes
207L00000X	Orthopaedic Surgery	Foot and ankle specialization; primary surgeons for metatarsal osteotomy and grafting
207P00000X	Podiatry	DPM specialists perform forefoot reconstructive surgery including grafting for metatarsal malunion/nonunion
2080P0005X	General Surgery	In select cases where general surgeons with orthopaedic training may participate (less common)
2080S0126X	Plastic Surgery	May be involved when soft tissue reconstruction or complex wound coverage is required
226100000X	Family Medicine	Uncommonly performs surgical repair; included when family physicians with surgical privileges perform foot procedures

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M84.372A`	Nonunion of fracture of right metatarsal, initial encounter	Nonunion indicating failure to achieve bone healing, direct indication for surgical repair with graft
`M84.371A`	Nonunion of fracture of left metatarsal, initial encounter	Same relevance for left-sided nonunion requiring operative intervention
`M84.372G`	Nonunion of fracture of right metatarsal, subsequent encounter	Used for follow-up encounters or if procedure occurs in a later encounter sequence
`M84.371G`	Nonunion of fracture of left metatarsal, subsequent encounter	As above, for subsequent care episodes
`M21.67`	Flat foot [pes planus] (acquired), unspecified foot	May be present as contributing deformity in complex forefoot pathology; requires consideration in reconstruction
`M20.2`	Hallux valgus (acquired)	Common coexisting forefoot deformity that may be addressed during reconstructive surgery
`M84.373A`	Nonunion of fracture of multiple metatarsals, initial encounter	Used when more than one metatarsal demonstrates nonunion requiring multi-site repair

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`28300`	Correction, hammertoe (metatarsophalangeal joint) ; without internal fixation	May be performed concurrently for toe deformities contributing to forefoot dysfunction; listed when additional corrective soft-tissue/bony work is done
`28285`	Osteotomy, metatarsal, with or without internal fixation, single metatarsal	Alternative or adjunct procedure when lengthening/shortening osteotomy is performed on a metatarsal; may be component or separate CPT depending on technique
`28820`	Repair, tendon, flexor or extensor, foot; primary or secondary	Performed when tendon pathology is addressed during the same operative session
`20680`	Removal of deep fixation device, musculoskeletal system	Used when prior hardware is removed before corrective osteotomy and graft placement
`11010`	Debridement, skin, subcutaneous tissue; complicated (e.g., for infected nonunion)	Applied when there is infected nonunion requiring extensive wound debridement prior to grafting

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