CPT 28360 Cleft Foot Reconstruction Reimbursement | OpenPayer

Summary & Overview

CPT 28360: Cleft Foot Reconstruction

CPT code 28360 represents surgical reconstruction for cleft foot, a congenital anomaly in which a V-shaped cleft and possible toe absence affect foot anatomy and function. This procedure addresses structural abnormalities to restore foot contour and mobility, and is relevant for pediatric and reconstructive orthopedic services nationally. The code is used in surgical billing for hospitals and ambulatory surgical centers that perform corrective foot reconstruction.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, an overview of typical sites of service, and benchmarks commonly used in payer coverage discussions. The publication also summarizes common modifiers and payor considerations where available, and outlines areas where policy updates or utilization patterns are relevant to hospitals and surgical practices.

This summary is intended for clinical managers, billing professionals, and policy analysts seeking a national view of the code’s clinical role, site-of-service implications, and payer coverage landscape. Data not available in the input is noted explicitly in relevant sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 28360cleft footreconstructive surgerypediatric orthopedicsfoot surgeryambulatory surgeryhospital services

Billing Code Overview

CPT code 28360 describes surgical reconstruction for a cleft foot, a congenital deformity characterized by a V-shaped cleft of the foot that may extend toward the ankle and can include absent toes. The procedure involves reconstruction of the foot and removal or closure of the cleft to restore form and function.

Service type: Surgical repair / reconstructive procedure

Typical site of service: Hospital operating room or ambulatory surgical center

Clinical & Coding Specifications

Clinical Context

A newborn or pediatric patient is referred to pediatric orthopedics or pediatric plastic surgery for congenital cleft foot (oligodactyly with a central V-shaped cleft of the foot). The typical presentation is a cosmetically and functionally limiting cleft with variable absence or malformation of toes, medial or lateral clefting, and associated syndactyly in some cases. Preoperative evaluation includes clinical examination, weight-bearing or supine foot radiographs to assess bony anatomy and toe presence, and discussion with the family regarding goals of reconstruction (improved foot contour, shoe fitting, and ambulation). Surgical workflow: the patient undergoes general anesthesia in an operating room or ambulatory surgical center; the surgeon marks planned incisions to excise soft tissue in the cleft and reconstruct the foot by approximating medial and lateral soft tissues and, when indicated, performing soft tissue flaps, tendon balancing, or osteotomies. Hemostasis, layered closure, and dressing/casting are applied. Typical site of service: hospital operating room or ambulatory surgery center. Postoperative care includes short inpatient observation or discharge same day, wound checks, dressing/cast changes, and follow-up for potential staged procedures for toe reconstruction or orthotic management.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, or complexity substantially exceeds typical for the procedure due to extensive reconstruction.

CPT 28272: Interphalangeal Joint Capsulotomy, Toe Contracture Release

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

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

CPT-28296-BUNION-DISTAL-METATARSAL-OSTEOTOMY

CPT 28296: Bunion Correction with Distal Metatarsal Osteotomy

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

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

CPT-28299-BUNION-DOUBLE-OSTEOTOMY-FOOT

CPT 28299: Bunion Correction with Double Osteotomy

CPT-28226-TENOLYSIS-EXTENSOR-TENDONS-FOOT

CPT 28226: Tenolysis of Extensor Tendons of Foot

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

CPT 28307: First Metatarsal Osteotomy with Autogenous Bone Graft

CPT-28295-BUNION-CORRECTION-PROXIMAL-METATARSAL-OSTEOTOMY

CPT 28295: Bunion Correction with Proximal Metatarsal Osteotomy

CPT-28210-DELAYED-TENDON-REPAIR-WITH-AUTOGRAFT-FOOT

CPT 28210: Delayed Tendon Repair of Foot/Toes with Autograft

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

CPT 28309: Osteotomy of Multiple Metatarsals for Pes Cavus

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Taxonomy Code	Specialty	Notes
207RP0101X	Pediatric Orthopedic Surgery	Pediatric orthopedists commonly perform congenital foot reconstructions.
208000000X	Orthopedic Surgery	General orthopedists with pediatric experience perform this procedure.
208U00000X	Plastic Surgery	Pediatric plastic surgeons perform soft-tissue reconstruction and contouring.
2080P0223X	Pediatric Surgery	Pediatric surgeons may be involved in multidisciplinary care when syndromic anomalies present.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Q66.8`	Other congenital deformities of feet	Covers congenital cleft foot presentations when a more specific code is not available.
`Q66.9`	Congenital deformity of limb, unspecified	Used when limb deformity is described without specific foot code.
`Q72.2`	Congenital absence of unspecified toe(s)	Relevant when toes are missing as part of cleft foot.
`Q79.8`	Other congenital malformations of peripheral limbs	Used for associated limb anomalies in syndromic cases.
`M21.7`	Other acquired deformities of foot	Occasionally used for later acquired or secondary deformity after initial treatment.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`20680`	Resection; benign tumor or cyst, soft tissue of foot or toe	Removal of accessory soft-tissue masses or excised tissue during cleft closure.
`28200`	Correction, hallux valgus (bunion), with or without sesamoidectomy; with metatarsal osteotomy	May be performed in staged reconstruction if forefoot alignment requires osteotomy.
`28292`	Correction, hammertoe (Taylor-type) any method, per toe	Toe deformity corrections that may be performed concurrently or in staged procedures.
`28820`	Stabilization, ankle, arthrodesis, arthrodesis joint	Not commonly primary to cleft closure but may be pertinent if associated structural deformity requires fusion; used rarely.
`12001`	Simple repair of superficial wounds (for example, nailbed/ skin)	Used for small skin repairs or revisions in the immediate postoperative period.

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