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CPT 28446: Osteochondral Autograft of the Talus, Open

CPT code 28446 denotes an open osteochondral autograft of the talus to treat symptomatic osteochondritis dissecans (OCD) lesions. This procedure relocates healthy bone–cartilage plugs from the patient to the damaged talar surface to restore joint congruity and function. Nationally, the code captures surgical management for focal talar cartilage defects that have failed conservative care and is relevant to orthopedic, podiatric, and surgical billing and policy reviews.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and what to expect in coverage and billing conversations. The publication summarizes common billing considerations and identifies where additional documentation and clinical justification are typically required for surgical repair of talar OCD.

This piece provides benchmarks and policy-oriented context for coding and utilization of 28446, outlines typical payer engagement for surgical ankle reconstruction, and summarizes clinical indications tied to the procedure. Data not available in the input are noted where applicable.

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Billing Code Overview

CPT code 28446 describes an osteochondral autograft of the talus performed through an open incision to treat a symptomatic osteochondritis dissecans (OCD) lesion. The procedure transfers healthy osteochondral tissue from one area of the patient’s body to a defective area of the ankle bone to restore joint surface integrity and relieve symptoms.

Service type: Surgical reconstruction of the talar articular surface (open osteochondral autograft)
Typical site of service: Inpatient or outpatient hospital operating room, or ambulatory surgery center, depending on clinical complexity and facility resources.

Data not available in the input.

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CPT 28446: Osteochondral Autograft of the Talus, Open

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Get alerted when payer policies referencing 28446 are released or updated.

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Billing Code Overview

Service type: Surgical reconstruction of the talar articular surface (open osteochondral autograft)
Typical site of service: Inpatient or outpatient hospital operating room, or ambulatory surgery center, depending on clinical complexity and facility resources.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 28-year-old recreational soccer player presents with months of persistent anterolateral ankle pain, swelling, and intermittent catching after a twisting injury. Imaging (MRI) demonstrates a symptomatic osteochondritis dissecans (OCD) lesion of the talar dome with a focal full-thickness chondral defect and subchondral bone loss. Conservative care including immobilization, physical therapy, and activity modification has failed.

The orthopedic foot and ankle surgeon schedules an open osteochondral autograft transfer system (OATS) procedure: through a small open incision over the ankle, healthy osteochondral plugs are harvested from the non–weight-bearing portion of the ipsilateral knee and transplanted into the talar defect to restore articular congruity. Typical perioperative workflow includes preoperative clinic evaluation, informed consent, regional or general anesthesia, intraoperative fluoroscopy, graft harvest and implantation, wound closure, and postoperative protocols for immobilization, protected weight-bearing, and rehabilitation. Typical site of service is an ambulatory surgery center or hospital outpatient department for patients requiring same-day discharge; inpatient admission is uncommon unless there are comorbidities or complications.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — default	Not used as a CMS modifier in standard lists; present in source list but use payer-specific instructions if required
`11`	Office or other outpatient visit for evaluation and management (example CMS-specific)	Applied per payer when reporting usual procedural services in outpatient setting if payer requires
`22`	Increased procedural services	When the work, time, or complexity substantially exceeds the typical service for `28446` (rare; requires documentation)
`23`	Unusual anesthesia	When general anesthesia is required for medical reasons and the procedure would typically be performed under regional or local anesthesia
`26`	Professional component	When only the physician professional component of a service is reported separate from technical component (rare for surgical procedure codes)
`50`	Bilateral procedure	When the osteochondral autograft is performed on both talar domes during the same operative session (use payer bilateral reporting rules)
`51`	Multiple procedures	When `28446` is performed in the same operative session with other distinct procedures; report per payer bundling rules
`52`	Reduced services	When `28446` is partially reduced or not completed as initially planned but still performed to a lesser extent
`54`	Surgical care only	When the surgeon bills only for the surgical portion and another provider bills pre/postoperative care (use per payer rules)
`76`	Repeat procedure by same physician	When the same physician repeats `28446` during the postoperative global period (if clinically warranted)
`78`	Unplanned return to the operating room by the same physician following initial procedure for a related procedure during the global period	Use if patient requires an unplanned reoperation related to the initial `28446` during the global period
`80`	Assistant surgeon	When an assistant surgeon is required and meets payer criteria for reporting an assistant at surgery
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	When a qualified non-physician assistant performs assistant-at-surgery duties per payer policy

Taxonomy Code	Specialty	Notes
`207X00000X`	Orthopaedic Surgery	Foot and ankle surgeons perform `28446`; primary specialty for this procedure
`2080P0222X`	Podiatric Medicine and Surgery	Podiatric surgeons who perform advanced ankle procedures may perform osteochondral grafting
`208600000X`	Sports Medicine (Orthopaedic)	Orthopaedic sports medicine specialists commonly manage talar OCD lesions and perform grafting
`2084P0800X`	Orthopaedic Surgery of the Lower Extremity	Subspecialty taxonomy for surgeons focused on lower extremity reconstructions
`207L00000X`	Hand Surgery (if applicable)	Not typical — included for completeness of orthopaedic taxonomy variations

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M93.27`	Osteochondritis dissecans, ankle and foot	Primary diagnosis indicating OCD lesion of the talus treated by osteochondral autograft
`M24.271`	Other articular cartilage disorders, right ankle	Indicates focal chondral defect of the ankle; may be used when specific OCD code is not chosen
`M24.272`	Other articular cartilage disorders, left ankle	As above for the contralateral side
`S99.811A`	Other specified injury of right ankle, initial encounter	Used when there is an associated traumatic ankle injury contributing to OCD symptoms
`S99.812A`	Other specified injury of left ankle, initial encounter	Same as above for left side

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27695`	Repair, primary, Achilles tendon rupture, open; with graft (includes obtaining graft)	May be performed in cases with concurrent tendon pathology or when graft harvest/repair is required in the same operative session
`29899`	Unlisted procedure, arthroscopy	Used if arthroscopic techniques or unique arthroscopic steps to the talus are performed that are not described by a specific code; report with documentation
`27370`	Osteochondral graft, autograft, knee, open (including obtaining graft)	Codes describing osteochondral autograft harvest from the knee; used to report graft harvest sites when documented and separately reportable per payer rules
`27650`	Repair, primary, flexor tendon, ankle and/or foot; end-to-end	May be reported when concomitant tendon repair is performed during the same surgical session
`28899`	Unlisted procedure, foot; unlisted surgical procedure	Used when a specific talar osteochondral repair does not fit existing codes and payer requires an unlisted code with operative report

CPT 28400: Closed Treatment of Calcaneal (Heel) Fracture

CPT-28405-CLOSED-TREATMENT-CALCANEAL-FRACTURE

CPT 28405: Closed Treatment of Calcaneal Fracture

CPT-28406-CALCANEAL-FRACTURE-OPEN-FIXATION

CPT 28406: Open Reduction, Internal Fixation of Calcaneal Fracture

CPT-28415-CALCANEAL-FRACTURE-OPEN-REDUCTION-INTERNAL-FIXATION

CPT 28415: Open Surgical Treatment of Calcaneal Fracture

CPT-28420-OPEN-CALCANEAL-FRACTURE-FIXATION-WITH-BONE-GRAFT

CPT 28420: Open Calcaneal Fracture Repair with Cancellous Bone Graft

CPT-28430-TALUS-FRACTURE-STABILIZATION-IMMOBILIZATION

CPT 28430: Stabilization of Nondisplaced Talus Fracture

CPT-28435-CLOSED-TREATMENT-TALUS-FRACTURE-MANIPULATION

CPT 28435: Closed Treatment of Talus Fracture with Manipulation

CPT-28436-TALUS-FRACTURE-PERCUTANEOUS-FIXATION-MANIPULATION

CPT 28436: Closed Talus Fracture Manipulation with Percutaneous Fixation

CPT-28445-OPEN-TREATMENT-TALUS-FRACTURE

CPT 28445: Open Treatment of Talus Fracture

CPT-28450-CLOSED-TREATMENT-TARSAL-BONE-FRACTURE

CPT 28450: Closed Treatment of Tarsal Bone Fracture, Non-manipulative

Showing 1–10 of 46

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — default	Not used as a CMS modifier in standard lists; present in source list but use payer-specific instructions if required
`11`	Office or other outpatient visit for evaluation and management (example CMS-specific)	Applied per payer when reporting usual procedural services in outpatient setting if payer requires
`22`	Increased procedural services	When the work, time, or complexity substantially exceeds the typical service for `28446` (rare; requires documentation)
`23`	Unusual anesthesia	When general anesthesia is required for medical reasons and the procedure would typically be performed under regional or local anesthesia
`26`	Professional component	When only the physician professional component of a service is reported separate from technical component (rare for surgical procedure codes)
`50`	Bilateral procedure	When the osteochondral autograft is performed on both talar domes during the same operative session (use payer bilateral reporting rules)
`51`	Multiple procedures	When `28446` is performed in the same operative session with other distinct procedures; report per payer bundling rules
`52`	Reduced services	When `28446` is partially reduced or not completed as initially planned but still performed to a lesser extent
`54`	Surgical care only	When the surgeon bills only for the surgical portion and another provider bills pre/postoperative care (use per payer rules)
`76`	Repeat procedure by same physician	When the same physician repeats `28446` during the postoperative global period (if clinically warranted)
`78`	Unplanned return to the operating room by the same physician following initial procedure for a related procedure during the global period	Use if patient requires an unplanned reoperation related to the initial `28446` during the global period
`80`	Assistant surgeon	When an assistant surgeon is required and meets payer criteria for reporting an assistant at surgery
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	When a qualified non-physician assistant performs assistant-at-surgery duties per payer policy

Taxonomy Code	Specialty	Notes
`207X00000X`	Orthopaedic Surgery	Foot and ankle surgeons perform `28446`; primary specialty for this procedure
`2080P0222X`	Podiatric Medicine and Surgery	Podiatric surgeons who perform advanced ankle procedures may perform osteochondral grafting
`208600000X`	Sports Medicine (Orthopaedic)	Orthopaedic sports medicine specialists commonly manage talar OCD lesions and perform grafting
`2084P0800X`	Orthopaedic Surgery of the Lower Extremity	Subspecialty taxonomy for surgeons focused on lower extremity reconstructions
`207L00000X`	Hand Surgery (if applicable)	Not typical — included for completeness of orthopaedic taxonomy variations

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M93.27`	Osteochondritis dissecans, ankle and foot	Primary diagnosis indicating OCD lesion of the talus treated by osteochondral autograft
`M24.271`	Other articular cartilage disorders, right ankle	Indicates focal chondral defect of the ankle; may be used when specific OCD code is not chosen
`M24.272`	Other articular cartilage disorders, left ankle	As above for the contralateral side
`S99.811A`	Other specified injury of right ankle, initial encounter	Used when there is an associated traumatic ankle injury contributing to OCD symptoms
`S99.812A`	Other specified injury of left ankle, initial encounter	Same as above for left side

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27695`	Repair, primary, Achilles tendon rupture, open; with graft (includes obtaining graft)	May be performed in cases with concurrent tendon pathology or when graft harvest/repair is required in the same operative session
`29899`	Unlisted procedure, arthroscopy	Used if arthroscopic techniques or unique arthroscopic steps to the talus are performed that are not described by a specific code; report with documentation
`27370`	Osteochondral graft, autograft, knee, open (including obtaining graft)	Codes describing osteochondral autograft harvest from the knee; used to report graft harvest sites when documented and separately reportable per payer rules
`27650`	Repair, primary, flexor tendon, ankle and/or foot; end-to-end	May be reported when concomitant tendon repair is performed during the same surgical session
`28899`	Unlisted procedure, foot; unlisted surgical procedure	Used when a specific talar osteochondral repair does not fit existing codes and payer requires an unlisted code with operative report

CPT 28400: Closed Treatment of Calcaneal (Heel) Fracture

CPT-28405-CLOSED-TREATMENT-CALCANEAL-FRACTURE

CPT 28405: Closed Treatment of Calcaneal Fracture

CPT-28406-CALCANEAL-FRACTURE-OPEN-FIXATION

CPT 28406: Open Reduction, Internal Fixation of Calcaneal Fracture

CPT-28415-CALCANEAL-FRACTURE-OPEN-REDUCTION-INTERNAL-FIXATION

CPT 28415: Open Surgical Treatment of Calcaneal Fracture

CPT-28420-OPEN-CALCANEAL-FRACTURE-FIXATION-WITH-BONE-GRAFT

CPT 28420: Open Calcaneal Fracture Repair with Cancellous Bone Graft

CPT-28430-TALUS-FRACTURE-STABILIZATION-IMMOBILIZATION

CPT 28430: Stabilization of Nondisplaced Talus Fracture

CPT-28435-CLOSED-TREATMENT-TALUS-FRACTURE-MANIPULATION

CPT 28435: Closed Treatment of Talus Fracture with Manipulation

CPT-28436-TALUS-FRACTURE-PERCUTANEOUS-FIXATION-MANIPULATION

CPT 28436: Closed Talus Fracture Manipulation with Percutaneous Fixation

CPT-28445-OPEN-TREATMENT-TALUS-FRACTURE

CPT 28445: Open Treatment of Talus Fracture

CPT-28450-CLOSED-TREATMENT-TARSAL-BONE-FRACTURE

CPT 28450: Closed Treatment of Tarsal Bone Fracture, Non-manipulative

Showing 1–10 of 46

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 28446: Osteochondral Autograft of the Talus, Open

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Billing Code Overview

OpenPayer

CPT 28446: Osteochondral Autograft of the Talus, Open

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References