Summary & Overview
CPT 28495: Closed Treatment, Great Toe Phalanx Fracture
CPT code 28495 represents closed treatment with manipulation of a fracture involving the phalanx or phalanges of the great toe. This code captures non‑operative alignment procedures that avoid incision and internal fixation and is commonly used in acute orthopedic and podiatric care for the hallux. Nationally, accurate use of this code affects billing consistency for emergency departments, outpatient orthopedic clinics, and ambulatory surgical centers where toe fractures are managed.
Key payers typically referenced in national analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on the clinical setting and procedure scope, common payer coverage considerations, and typical service locations. The publication outlines benchmarks for utilization and reimbursement patterns where available, discusses coding and billing implications for closed manipulation of great toe fractures, and provides clinical context to help coding and compliance teams align documentation with the procedure performed.
This summary is intended for a national audience of clinicians, coding professionals, and healthcare policy analysts seeking a concise reference on CPT code 28495, its clinical meaning, and the payer landscape relevant to non‑operative toe fracture management.
Billing Code Overview
CPT code 28495 describes the closed treatment of a fracture of the phalanx or phalanges of the great toe with manipulation. The procedure involves manual adjustment or manipulation of the fractured bone(s) in the great toe (hallux) to restore alignment without an open surgical approach.
Service type: Closed fracture management with manipulation.
Typical site of service: Outpatient orthopedic clinic, emergency department, or ambulatory surgical center, depending on clinical context and need for sedation or observation.
Clinical & Coding Specifications
Clinical Context
A 28-year-old recreational soccer player presents to the emergency department after stubbing the right great toe during play. The patient reports immediate pain, swelling, and difficulty weight-bearing. Physical exam shows deformity and focal tenderness over the proximal phalanx of the right hallux with limited range of motion. Plain radiographs confirm a displaced, closed fracture of the proximal phalanx of the great toe without open skin disruption.
The clinical workflow for 28495 involves triage and pain control in the ED, confirmation of the fracture with x-ray, informed consent for closed manipulation, and regional/local anesthesia or digital block. The provider performs closed reduction (manipulation) of the fractured phalanx under appropriate analgesia and obtains post-reduction radiographs to confirm alignment. The patient receives immobilization (e.g., toe splint, postoperative shoe), wound/injury aftercare instructions, and scheduling for follow-up to monitor healing and potential referral to podiatry or orthopedic surgery if reduction is unstable.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | Use when the procedure is performed on the left great toe. |