CPT 28810 Reimbursement & Benchmarks | OpenPayer

Summary & Overview

CPT 28810: Amputation of Single Metatarsal and Attached Toe

CPT code 28810 represents the surgical amputation of a single metatarsal bone together with its attached toe. This procedure is a discrete forefoot amputation used in settings where preservation of limb length or removal of diseased tissue necessitates resection of a metatarsal and the corresponding digit. Nationally, reporting accurate procedural coding for such amputations is important for case mix, quality measurement, and appropriate reimbursement for surgical and post-operative care.

Key payers in the national landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical description of the procedure, typical places of service, common payer considerations, and references to related billing elements. The publication addresses coding context, expected sites of service (operating room, ambulatory surgical center, or inpatient surgical setting), and clinical scenarios that commonly lead to metatarsal and toe amputation.

This summary prepares clinicians, coders, and policy analysts to understand where CPT code 28810 fits within surgical foot procedures, what to expect in terms of care setting, and which national payers commonly cover the service. Data not available in the input will be noted where applicable in other sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare28810CPTfoot surgeryamputationmetatarsalambulatory surgeryoperating roomsurgical procedureorthopedics

Billing Code Overview

CPT code 28810 describes the amputation of a single metatarsal bone with its attached toe. The procedure involves surgical removal of one of the five long metatarsal bones of the foot along with the corresponding toe (phalanges).

Service type: Surgical amputation of a single metatarsal and toe
Typical site of service: Operating room or ambulatory surgical center; may also occur in an inpatient surgical setting depending on clinical complexity and patient needs

Clinical & Coding Specifications

Clinical Context

A 62-year-old male with long-standing peripheral vascular disease and poorly controlled diabetes presents with a nonhealing, gangrenous second toe and osteomyelitis isolated to the second metatarsal on imaging. After multidisciplinary evaluation, the patient is scheduled for surgical removal of the affected toe and its single metatarsal (transmetatarsal partial amputation of a single metatarsal and attached toe) to control infection and preserve limb function. Typical workflow includes preoperative assessment (vascular and infectious disease clearance, optimization of glycemic control), perioperative antibiotics, regional or general anesthesia, operative removal of the single metatarsal with careful hemostasis and soft-tissue management, intraoperative cultures and pathology specimen submission, and postoperative wound care with a plan for offloading, possible negative-pressure therapy, and follow-up for rehabilitation and prosthetic or orthotic evaluation.

Coding Specifications

Modifier	Description	When to Use
`LT` / `RT`	Left or Right side designator	Use to indicate which foot (left or right) the amputation was performed on.
`50`

CPT 28825: Toe Amputation at Interphalangeal Joint

CPT-28820-TOE-AMPUTATION-METATARSOPHALANGEAL-JOINT

CPT 28820: Amputation of Toe at Metatarsophalangeal Joint

CPT-28805-METATARSAL-LEVEL-PARTIAL-FOOT-AMPUTATION

CPT 28805: Metatarsal-Level Partial Foot Amputation

CPT-28800-MIDTARSAL-TRANSVERSE-TARSAL-AMPUTATION

CPT 28800: Midtarsal (Transverse Tarsal) Foot Amputation

Taxonomy Code	Specialty	Notes
`2080S0106X`	Podiatric Surgeon	Podiatrists commonly perform metatarsal and toe amputations.
`207L00000X`	Orthopedic Surgery	Orthopedic foot and ankle surgeons perform metatarsal amputations, especially with complex reconstruction needs.
`208600000X`	General Surgery	General surgeons may perform foot amputations in trauma or severe infection when other specialists are not available.
`193400000X`	Vascular Surgery	Vascular surgeons are often involved preoperatively for revascularization planning in ischemic limb disease.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M86.171`	Acute osteomyelitis, right toe	Osteomyelitis localized to toe/metatarsal commonly indicates need for surgical resection of infected bone.
`M86.172`	Acute osteomyelitis, left toe	Same as above for the opposite side.
`L97.412`	Non-pressure chronic ulcer of left heel and midfoot with fat layer exposed	Chronic nonhealing foot ulcers often progress to underlying bone infection requiring amputation.
`I70.233`	Atherosclerosis of native arteries of extremities with ulceration, bilateral legs	Peripheral arterial disease with ulceration contributes to poor wound healing and may precipitate amputation.
`E11.621`	Type 2 diabetes mellitus with foot ulcer	Diabetes with foot ulcer is a common antecedent to toe/metatarsal amputation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`28810`	Amputation, metatarsal, single, with toe; this code represents the operative removal of a single metatarsal and its attached toe.	Primary procedure: describes the definitive surgical amputation of one metatarsal and toe.
`11042`	Debridement, subcutaneous tissue (includes skin when performed), initial; 2.5 cm to 7.5 cm.	May be performed preoperatively or as part of wound care for infected tissue debridement prior to or following definitive amputation.
`11043`	Debridement, muscle and/or fascia, first 2.5 cm to 7.5 cm.	Used when deeper infected or necrotic soft tissue requires operative debridement in conjunction with amputation.
`87070`	Culture, bacterial, aerobic with isolation and presumptive identification of isolates; urine or catheterized specimen (Note: alternative culture codes like `87075`/`87076` may be used based on specimen).	Intraoperative wound or bone cultures are commonly submitted to guide antimicrobial therapy.
`11044`	Debridement, bone (eg, open or through fistula) first 2.5 cm to 7.5 cm	Used when infected bone (osteomyelitis) is debrided in addition to amputation.
`29580`	Application of multi-layer compression (eg, for edema control)	May be used postoperatively for limb edema control and dressing application as part of postoperative management.

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