Summary & Overview
CPT 28485: Open Treatment of Metatarsal Fracture
CPT code 28485 represents open treatment of a metatarsal fracture, a common surgical intervention to restore alignment and stability to one of the five long bones in the forefoot. This code captures procedures that may involve internal fixation with pins or screws but also covers open repairs without implant use. Nationally, metatarsal fractures are frequent in orthopedic and trauma practices, and proper coding ensures appropriate capture of surgical complexity and site-of-service utilization.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes how CPT code 28485 is used across payers, common billing and claim considerations, and the clinical context that typically justifies the procedure.
Readers will learn the clinical scope of the code, expected sites of service, and the types of surgical care it represents. The overview provides benchmarks and policy-relevant context for payers and providers, highlights payer coverage patterns where available, and outlines implications for surgical documentation and claim submission. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 28485 describes open treatment of metatarsal fracture, a surgical procedure to repair one of the five long bones of the forefoot (metatarsals). The procedure may include internal fixation using implants such as pins or screws but can also be performed without internal fixation depending on the fracture pattern and surgeon judgment.
Service type: Surgical — Open reduction and internal or external fixation of foot fracture
Typical site of service: Hospital operating room or ambulatory surgery center, depending on patient condition and resource needs.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 32-year-old recreational soccer player presents to the emergency department after an acute inversion injury to the forefoot. Radiographs demonstrate a displaced transverse fracture of the second metatarsal with cortical step-off and shortening. After initial assessment, closed reduction in the ED is unsuccessful in achieving acceptable alignment. The orthopedic foot and ankle surgeon schedules the patient for surgical management: open treatment of the metatarsal fracture with possible internal fixation using screws or pins. The typical workflow includes preoperative evaluation and consent, anesthesia (regional block or general), open reduction with debridement of hematoma and fracture site, fixation as indicated (percutaneous or plate/screw fixation), intraoperative fluoroscopy to confirm reduction, wound closure, sterile dressing and immobilization (splint or walking boot), postoperative pain control, and discharge with outpatient follow-up for wound check and progressive weight-bearing guidance.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Distinct Procedural Service | Use when a separate and distinct procedure is performed on the same day at a different anatomic site or when separate from another bundled procedure. |
52 |