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