Summary & Overview
CPT 28737: Navicular‑Cuneiform Arthrodesis with Tibialis Posterior Lengthening
CPT code 28737 represents a combined midfoot reconstructive procedure — fusion (arthrodesis) of the navicular and cuneiform tarsal bones with internal fixation, performed with lengthening and advancement of the tibialis posterior tendon. This code captures complex foot and ankle surgery that addresses midfoot collapse, deformity, or tendon dysfunction and is clinically significant because it often affects mobility and long‑term function.
Key national payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what CPT 28737 denotes clinically and operationally, how it is typically delivered (surgical setting, fixation techniques, and tendon procedure), and what to expect in payer coverage contexts. The publication provides national benchmarking context where available, notes common procedural modifiers in use, and summarizes relevant clinical considerations that influence coding and claim adjudication. Policy updates affecting surgical bundling, site‑of‑service determinations, and prior authorization trends for foot and ankle reconstructive procedures are highlighted.
This document is intended for billing professionals, clinicians, and policy analysts seeking a clear, national‑level briefing on CPT 28737, including clinical scope, service delivery setting, and the payer landscape relevant to utilization and reimbursement.
Billing Code Overview
CPT code 28737 describes a surgical procedure that achieves arthrodesis (fusion) of the navicular and cuneiform tarsal bones using internal fixation devices such as screws, K‑wires, or plates, combined with lengthening and advancement of the tibialis posterior tendon. The operation addresses structural instability and deformity of the midfoot by stabilizing the medial column and correcting tendon imbalance.
Service Type: Surgical — foot and ankle reconstructive procedure
Typical Site of Service: Hospital operating room or ambulatory surgery center (inpatient or outpatient surgical setting)
Clinical & Coding Specifications
Clinical Context
A 45-year-old patient presents with progressive medial midfoot pain, collapsing arch and difficulty with ambulation after failed conservative care for stage II adult acquired flatfoot deformity. Physical exam demonstrates flexible hindfoot deformity, tenderness over the naviculocuneiform joint, and dysfunction of the tibialis posterior tendon with decreased inversion strength. Weightbearing radiographs show talonavicular and naviculocuneiform instability with early degenerative changes.
Surgical workflow: the patient undergoes forefoot and midfoot exposure in an operating room setting under general or regional anesthesia. The surgeon performs naviculocuneiform arthrodesis with debridement of cartilage, placement of internal fixation (screws or plate, +/- K-wire provisional fixation), and reduction of deformity. A tibialis posterior tendon lengthening and advancement/transfer is performed to restore tendon tension and medial column alignment. Intraoperative imaging confirms hardware position and joint fusion alignment. Postoperative plan includes immobilization in a cast or boot, nonweightbearing for a period, routine wound checks, and radiographic follow-up to confirm fusion.
Typical site of service: hospital operating room or ambulatory surgery center. Service type: major reconstructive foot surgery with internal fixation and tendon procedure.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |