Summary & Overview
CPT 28490: Repair of Great Toe or Phalanx Fracture Without Surgery
CPT code 28490 represents nonoperative repair of a great toe or phalanx fracture performed without surgical incision and without manipulation. Nationally, this code captures conservative management of toe fractures that do not require open reduction or closed manipulation, and it is used across emergency departments, outpatient clinics, and ambulatory care settings. The code matters because accurate reporting affects clinical records, care continuity, and payer adjudication for common musculoskeletal injuries.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, coding guidance implications, and common use cases for CPT code 28490. The publication outlines typical sites of service, service type, and common billing modifiers provided in the input. It also provides benchmarks and policy considerations where available. Specifics on associated taxonomies, ICD-10 diagnoses, and related codes are noted when present; where those data elements are not provided, the report indicates that they are not available in the input.
Billing Code Overview
CPT code 28490 describes the repair of a great toe or phalanx fracture performed without surgical incision and without manipulation. This procedure represents nonoperative management focused on external stabilization and wound care as needed.
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Service type: Fracture repair, nonoperative
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Typical site of service: Outpatient clinic, emergency department, or ambulatory surgical center depending on patient presentation and need for observation
Clinical & Coding Specifications
Clinical Context
A 34-year-old recreational soccer player presents to an urgent care clinic with a closed injury to the right great toe after stubbing it forcefully against a rigid object earlier the same day. The patient has focal pain, swelling, and localized ecchymosis at the proximal phalanx of the hallux and can ambulate with pain. Radiographs obtained in the clinic demonstrate a nondisplaced fracture of the proximal phalanx of the great toe without joint subluxation. The orthopedic or podiatric provider documents the diagnosis, performs a focused history and physical, reviews imaging, provides analgesia, applies a protective stiff-soled shoe or short walking boot, performs soft tissue wound check (none needed), and provides written return precautions and follow-up instructions.
Typical clinical workflow: initial evaluation and plain radiographs in an urgent care or outpatient orthopedics/podiatry clinic; conservative, nonoperative management without closed manipulation; application of immobilization (protective shoe, splint, or walking boot) and patient education; scheduled outpatient follow-up for repeat radiographs and reassessment. Usual sites of service: urgent care clinic, outpatient orthopedics or podiatry clinic, or ambulatory surgery center only if administrative location of service requires it for coding; this procedure is typically billed by the treating provider in an outpatient setting.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure |