CPT Code for Fifth Metatarsal Head Resection

If you are a medical coder, a podiatrist, or an orthopedic surgeon, you know that foot and ankle procedures can be tricky. One question that comes up often is simple on the surface: What is the right CPT code for a fifth metatarsal head resection?

But here is the truth. The answer is not always as straightforward as you might hope.

In this guide, we will walk through everything you need to know. We will look at the primary code, the differences between resection and excision, and how to avoid common denials. You will also learn when to use modifiers and how to document this procedure correctly.

Let us start with the direct answer, and then we will unpack the details.

The Short Answer: Primary CPT Code

The most accurate CPT code for a fifth metatarsal head resection is:

CPT 28122 – Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) of phalanx or metatarsal, each

This code covers the partial removal of a metatarsal bone. Since the fifth metatarsal head is the rounded, distal end of the bone, removing it qualifies as a partial metatarsal excision.

However, you must pay attention to one critical detail. Code 28122 is defined as “each” bone. If your surgeon operates on multiple metatarsal heads (for example, the second, third, and fifth), you will need to report 28122 multiple times. But we will talk about bundling rules later.

Important Note: Do not confuse 28122 with a complete metatarsal resection. If the surgeon removes the entire fifth metatarsal bone, the code changes completely. We will cover that distinction in the next section.

Code 28122 vs. Other Common Codes

One of the biggest mistakes we see in podiatry coding is using the wrong excision code. Let us compare 28122 with other codes that sound similar but mean very different things.

As you can see, context matters. The operative report must clearly state that the surgeon removed only the head of the fifth metatarsal. If the report mentions “complete metatarsal resection” or “entire fifth metatarsal,” you should look at CPT 28140 instead.

When Is a Fifth Metatarsal Head Resection Necessary?

Before we dive deeper into coding, let us quickly understand why a surgeon performs this procedure. Knowing the medical necessity helps you defend your coding choice.

Surgeons typically resect the fifth metatarsal head for these reasons:

• Chronic bunionette (Tailor’s bunion). This is the most common reason. A bony prominence on the outside of the foot causes pain and friction.

• Avascular necrosis (Freiberg’s infraction). When the bone tissue dies, removing the damaged head relieves symptoms.

• Severe osteoarthritis. Bone spurs and joint damage may require partial resection.

• Non-healing ulcer or infection. In some diabetic or neuropathic patients, removing the bone head helps offload pressure.

• Previous failed surgery. Sometimes a patient needs a revision procedure.

In each of these cases, the surgeon removes only the metatarsal head. They do not take the whole bone shaft or the base. That is why code 28122 fits perfectly.

Documentation Requirements for 28122

You can pick the right code. But if the documentation does not support it, the payer will deny the claim. Here is what your surgeon’s operative note must include to justify CPT 28122.

Required Elements in the Operative Report

• Preoperative diagnosis: Mention the specific condition (e.g., “Tailor’s bunion of the right fifth metatarsal”).

• Procedure name: “Partial resection of the fifth metatarsal head.”

• Laterality: Left or right foot. You will need a modifier if the surgeon operates on both feet.

• Approach: Lateral incision or dorsal incision.

• Specific bone and location: “We resected the distal head of the fifth metatarsal.”

• Extent of resection: “Partial” or “the head only” – not the whole metatarsal.

• Intraoperative findings: Describe the bone deformity, cartilage damage, or necrosis.

A Sample Documentation Snippet

“After exposing the lateral aspect of the right fifth metatarsophalangeal joint, we identified a large bony prominence over the metatarsal head. Using a sagittal saw, we performed a partial osteotomy, resecting the lateral portion of the fifth metatarsal head. The remaining metatarsal shaft and base were intact. The joint was then irrigated and closed in layers.”

This note clearly supports 28122. It says “partial” and specifies the head only.

Modifiers to Use With CPT 28122

Modifiers are not always necessary for a single procedure. But in certain situations, you will need them. Let us review the most common modifiers for fifth metatarsal head resection.

Modifier 50 – Bilateral Procedure

If the surgeon performs a fifth metatarsal head resection on both feet during the same operative session, you have two choices:

• Report 28122-50 (one line item with modifier 50)

• Report 28122-LT and 28122-RT (two line items, one for each foot)

Most payers accept both, but check your local carrier. Medicare prefers modifier 50 for bilateral procedures.

Modifier 59 – Distinct Procedural Service

What if the surgeon resects the fifth metatarsal head and performs another procedure on the same foot? For example, a bunionectomy on the first metatarsal plus a fifth metatarsal head resection.

In this case, you may need modifier 59 (or the more specific X modifiers like XS, XU). This tells the payer the two procedures are separate and not bundled.

Modifier RT and LT

Use these for laterality when you report two separate line items.

Bundling Issues: What Not to Bill Separately

Here is where many coders get into trouble. CPT 28122 includes certain components of the procedure. You cannot bill them separately unless something unusual happens.

Do Not Report These Separately

• Exposure of the joint (surgical approach). The incision and soft tissue dissection are part of 28122.

• Closure (skin suturing). Standard wound closure is included.

• Simple debridement of the bone. Removing small fragments from the cut is part of the resection.

• Local nerve block if performed by the surgeon for postoperative pain.

When You Can Bill Extra

You can add separate codes for:

• Complex closure (if the wound requires layered closure or flap, CPT 13100 series). But this is rare for a standard metatarsal head resection.

• Significant, separate ligament or tendon repair (e.g., repair of a ruptured peroneal tendon during the same surgery). Use modifier 59.

• Excision of a separate lesion (e.g., a ganglion cyst in a different location of the foot).

Note: Always check the National Correct Coding Initiative (NCCI) edits. They frequently update bundling rules.

Global Period and Postoperative Care

CPT 28122 carries a 90-day global period. This means the reimbursement for the surgery includes:

• The day of the procedure

• All routine postoperative visits for 90 days

• Simple dressing changes

• Suture removal

• Routine follow-up X-rays

If the patient returns to the operating room for a complication (e.g., infection, hematoma) within 90 days, you do not bill a new surgery code. Instead, you use a modifier like 78 (return to the OR for a related procedure).

If a different provider (not the surgeon) sees the patient for postoperative care, you may need to split the global period using modifiers 54 (surgical care only) and 55 (postoperative management only).

Medicare and Payer-Specific Guidelines

Medicare does not have a national coverage determination (NCD) specifically for fifth metatarsal head resection. However, local coverage determinations (LCDs) vary by region. Some Medicare Administrative Contractors (MACs) have specific requirements.

Common LCD Requirements

• Medical necessity must be clearly documented. “Pain” alone is not enough. You need objective findings like imaging evidence of a bony deformity.

• Failure of conservative treatment for at least 3 to 6 months (e.g., shoe modifications, padding, orthotics, activity modification).

• Radiographic confirmation of the bony prominence or joint destruction.

Commercial Payer Tips

Private insurers often follow Medicare’s lead. But some may require preauthorization for CPT 28122. Always verify:

• Does the plan require a referral?

• Is a second opinion needed?

• Is the procedure considered cosmetic? (Tailor’s bunion correction is usually not cosmetic, but some plans try to deny it.)

Common Coding Mistakes to Avoid

After reviewing thousands of foot surgery claims, we see the same errors over and over. Here are the top five mistakes with CPT 28122.

1. Using Code 28140 Instead of 28122

Mistake: Reporting a complete metatarsectomy when only the head was removed.
Consequence: Overcoding and potential fraud.
Solution: Read the op note carefully. Look for words like “complete,” “entire,” or “total metatarsal resection.”

2. Billing for an Osteotomy Separately

Mistake: Adding CPT 28300 (osteotomy of metatarsal) to 28122.
Consequence: Unbundling denial. The osteotomy is part of the head resection.
Solution: Do not separate the bone cut from the excision.

3. Missing Laterality Modifiers

Mistake: Reporting 28122 twice without LT/RT or 50.
Consequence: Payer will deny the second unit as a duplicate.
Solution: Always append laterality modifiers for bilateral or multiple procedures.

4. No Documentation of Conservative Care

Mistake: Submitting the claim without any history of failed non-surgical treatment.
Consequence: Medical necessity denial.
Solution: Ensure the clinic note mentions orthotics, padding, activity changes, or injections.

5. Forgetting the 90-Day Global Period

Mistake: Billing for an office visit two weeks after surgery as a new problem.
Consequence: The visit will be denied as part of the global package.
Solution: Only bill separate E/M visits if the patient has a new, unrelated condition.

Clinical Scenarios and Coding Examples

Let us apply what we have learned. Read each scenario and see which codes and modifiers you would choose.

Scenario 1: Simple Resection, Right Foot

Case: A 52-year-old woman with a painful Tailor’s bunion on the right foot. She tried wider shoes, padding, and activity modification for eight months without relief. The surgeon performs a partial resection of the right fifth metatarsal head.

Correct coding:

• CPT 28122-RT

Explanation: Single procedure, right side. No modifiers needed beyond laterality.

Scenario 2: Bilateral Resection

Case: A 60-year-old man with bilateral Tailor’s bunions. Both feet are painful. He fails conservative care. The surgeon resects the fifth metatarsal head on both feet during one surgery.

Correct coding (Option A – Medicare style):

• CPT 28122-50

Correct coding (Option B – Commercial payer):

• CPT 28122-RT

• CPT 28122-LT

Explanation: Use modifier 50 or split into two lines with RT/LT. Do not bill 28122 twice without modifiers.

Scenario 3: Fifth Metatarsal Head Resection + First Metatarsal Bunionectomy

Case: Same foot, right side. The surgeon performs a Chevron bunionectomy (CPT 28296) on the first metatarsal and a partial resection of the fifth metatarsal head (28122). Both are medically necessary.

Correct coding:

• CPT 28296-RT

• CPT 28122-RT-59 (or XU)

Explanation: The two codes are not normally bundled, but modifier 59 tells the payer these are distinct sites on the same foot.

Scenario 4: Complete Metatarsal Resection (Not Just the Head)

Case: A diabetic patient with a chronic, non-healing ulcer under the fifth metatarsal head. Osteomyelitis is present. The surgeon removes the entire fifth metatarsal bone from base to head.

Correct coding:

• CPT 28140-RT

Explanation: This is a complete metatarsectomy, not a partial head resection. Do not use 28122.

Reimbursement Rates and RVUs (2026)

Let us talk about money briefly. Reimbursement varies by payer, region, and facility type. But looking at the Relative Value Units (RVUs) gives you a solid benchmark.

These are estimated 2026 values. Always check the current Medicare Physician Fee Schedule.

As you can see, the complete metatarsectomy (28140) pays significantly more. That is another reason payers scrutinize partial resections. They want to ensure you are not upcoding to 28140.

How to Appeal a Denial for CPT 28122

Even with perfect coding, denials happen. If the payer denies your claim for 28122, follow these steps.

Step 1: Read the Denial Reason

Common denial codes for 28122 include:

• CO-50: Medical necessity not established.

• CO-97: The benefit for this service is not included in the plan.

• PR-2: Deductible or coinsurance (patient responsibility).

Step 2: Gather Your Evidence

You will need:

• The complete operative report

• Preoperative and postoperative X-rays

• Documentation of conservative treatment (dates and types)

• Clinical notes describing pain, functional limitation, and failed non-surgical care

Step 3: Write a Clear Appeal Letter

State the patient’s name, ID number, date of service, and denied CPT code. Then explain:

“The patient suffered from a symptomatic Tailor’s bunion of the right fifth metatarsal head, confirmed by X-ray. After six months of conservative management including wider footwear, gel padding, and activity modification, the patient continued to experience pain with ambulation. Therefore, CPT 28122 was medically necessary.”

Step 4: Submit the Appeal Within the Deadline

Most payers give you 120 to 180 days from the denial date. Do not wait.

Frequently Asked Questions (FAQ)

1. Is CPT 28122 the same as a bunionectomy?

No. A traditional bunionectomy (CPT 28296, 28297, etc.) is for the first metatarsal. The fifth metatarsal head resection is for a Tailor’s bunion or other conditions. They are not interchangeable.

2. Can I bill 28122 with an arthrodesis (joint fusion)?

Yes, but only if the procedures are separate and distinct. For example, a first metatarsophalangeal joint fusion (CPT 28270) and a fifth metatarsal head resection (28122) on the same foot would need modifier 59.

3. What is the difference between 28122 and 28124?

28122 is for the metatarsal bone. 28124 is for the phalanx (toe bone). Do not mix them up.

4. Does Medicare cover fifth metatarsal head resection?

Yes, if medical necessity is met. However, some local Medicare contractors consider it a “cosmetic” procedure for Tailor’s bunion alone. Always check your LCD.

5. How many units of 28122 can I bill?

You can bill one unit per metatarsal head. For the fifth metatarsal, that is one unit per foot. For multiple metatarsals (e.g., second, third, fourth, and fifth), you would report 28122 four times with modifiers.

6. What anesthesia code goes with 28122?

Common anesthesia codes for foot surgery include:

• 01462 (ankle and foot, not otherwise specified)

• 01470 (forefoot, metatarsal surgery)

Your anesthesia provider will choose the appropriate code based on the patient’s medical history.

7. Can a podiatrist bill 28122?

Yes. Podiatrists can bill this code within their scope of practice. Medicare and most commercial plans allow podiatrists to perform and bill for metatarsal head resections.

8. What if the surgeon uses a burr instead of a saw?

The technique does not change the code. Whether the surgeon uses a saw, a burr, or an osteotome, the correct code remains 28122 for a partial resection.

Additional Resources for Foot Surgery Coding

You do not have to memorize everything. Keep these resources handy:

• American Academy of Professional Coders (AAPC) – Foot Surgery Coding Toolkit
  https://www.aapc.com/coding-toolkits/foot-surgery-coding.aspx (External link, not affiliated)

• CMS National Correct Coding Initiative (NCCI) Edits
  Search for current bundling rules between 28122 and other codes.

• Your Local Medicare Administrative Contractor (MAC)
  Find your MAC’s LCD for metatarsal surgery.

Final Thoughts on Coding Fifth Metatarsal Head Resection

We have covered a lot of ground. Let us bring it all together.

CPT 28122 is the correct code for a fifth metatarsal head resection. But the code alone is never enough. You need strong documentation, the right modifiers, and a clear understanding of what is bundled. Payers will deny claims for missing laterality, poor medical necessity, or unbundling errors.

Your best defense is a clear operative report. Write down exactly what the surgeon did. Mention “partial,” “head only,” and “fifth metatarsal.” Include X-ray findings and failed conservative care.

When you do that, you protect your revenue and your reputation.

Conclusion

The correct CPT code for a fifth metatarsal head resection is 28122 (partial metatarsal excision). Always verify the operative report confirms “partial” removal of the head only, not the whole bone. Use modifiers like RT, LT, 50, or 59 as needed, and document conservative care to support medical necessity.

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FAQ Summary (Quick Reference)