You're staring at an operative report. Maybe it was a revision. Maybe it was a primary repair. The surgeon wrote "posterior tibial tendon repair" — maybe with a graft, maybe not. And now you're wondering: which CPT code actually fits?
Yeah. Been there.
The posterior tibial tendon is a workhorse. It holds up the medial arch. When it fails, the foot collapses. Surgery fixes it. But coding that surgery? That's where things get messy Simple as that..
Let's sort it out Simple, but easy to overlook..
What Is the Posterior Tibial Tendon Repair CPT Code
The primary code you'll use most often is 28200 Turns out it matters..
That's the CPT code for repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon. That said, posterior tibial tendon falls under "flexor, foot. " So 28200 covers a standard primary or secondary repair — no graft harvested from elsewhere.
But here's where it splits.
If the surgeon uses a free tendon graft — say, harvesting plantaris or using allograft — you're looking at 28202: repair, tendon, flexor, foot; with free graft (includes obtaining graft), each tendon.
And if they're doing a tendon transfer instead of a direct repair? That's a different conversation entirely. We'll get there.
Primary vs secondary — does it matter for coding?
Not for 28200 or 28202. Because of that, a secondary repair usually means more scar tissue, longer OR time, maybe a graft. On top of that, that supports 28202 if a graft is used. Here's the thing — " CPT doesn't distinguish. But your documentation better. Both codes say "primary or secondary.If not, it's still 28200 — but the op note should reflect the complexity Not complicated — just consistent..
Don't assume. Read the note Small thing, real impact..
Why This Code Trips People Up
Most coders don't mess up the base code. They mess up the modifiers, the bundling, and the clinical context.
Let's start with laterality. You need RT or LT. Always. Medicare and most payers will deny without it. And if the surgeon repaired both posterior tibial tendons in the same session — rare, but it happens — you'd bill 28200-RT and 28200-LT. Or 28200-50 if the payer accepts bilateral modifiers. Check your MAC.
Then there's the graft question.
Surgeons love to write "tendon repair with augmentation.Sometimes it means they wrapped the repair with extracellular matrix (like GraftJacket or AmnioFix). Now, ** CPT defines "free graft" as tissue harvested from a separate site or obtained as allograft. Sometimes it means a graft. A biologic wrap doesn't count. **That is not a free graft.Here's the thing — " Sometimes that means a suture anchor. Code 28200 The details matter here. Simple as that..
I've seen coders bill 28202 because "they used graft material." Nope. Not unless the op note says free tendon graft harvested from X or allograft tendon used.
What about tendon transfers?
Ah. The classic pivot.
If the posterior tibial tendon is too far gone — ruptured, retracted, degenerated — the surgeon might transfer the flexor digitorum longus (FDL) to the navicular. So naturally, that's not a repair. That's a transfer.
CPT code: 27691 — transfer or transplant of single tendon (with muscle redirection or rerouting); deep (eg, anterior tibial, posterior tibial, peroneal tendon).
Note: 27691 includes the harvest and the transfer. So you don't bill 28200 and 27691 for the same tendon. It's one or the other That's the part that actually makes a difference. Still holds up..
And if they do an FDL transfer plus a calcaneal osteotomy (like a medializing calcaneal osteotomy for stage 2 PTTD)? That's 27691 + 28300 (osteotomy, calcaneus). Both pay — if documented separately and medically necessary.
How It Works: Coding Step by Step
Let's walk through a real-world workflow. So you've got the op note open. Here's your checklist.
1. Identify the procedure performed
Read the procedure section — not just the heading. Surgeons often list "PTT repair" in the header but describe an FDL transfer in the body. Trust the body Nothing fancy..
Look for keywords:
- "Direct repair" → 28200 or 28202
- "Free tendon graft" / "allograft" / "harvested plantaris" → 28202
- "FDL transfer" / "tendon transfer to navicular" → 27691
- "Spring ligament repair" → separate code (28585? No — that's for fracture. Spring ligament repair is often unlisted, 29999, or bundled — more on that)
2. Check for grafts
If the note says "augmented with GraftJacket" or "wrapped with AmnioFix," that's not a free graft. Code 28200 Simple, but easy to overlook. Practical, not theoretical..
If it says "harvested plantaris tendon from contralateral leg" or "used Achilles allograft," that is a free graft. Code 28202.
And yes — harvesting the graft is included in 28202. Don't bill a separate harvest code.
3. Verify laterality
Right foot? RT. Consider this: left foot? Plus, lT. Which means bilateral? 50 or RT/LT — know your payer.
4. Check for bundled procedures
This is where money gets left on the table — or denials happen.
Common combos with PTT repair:
- Calcaneal osteotomy (28300) — medializing, lateralizing, or Dwyer. Don't bill separately. Still, , FHL tenolysis), maybe billable with 59 modifier. Still, separate incision? Usually yes. Bill it. Often done with PTT repair for forefoot varus. On the flip side, - Spring ligament repair — controversial. Others use 29999 (unlisted). Bill it.
- Medial cuneiform osteotomy (28306) — Cotton osteotomy. Some coders bill 28585 (repair of ligament, ankle). Bill it. Usually. Because of that, if different tendon (e. - Synovectomy — bundled. Day to day, **
- Gastrocnemius recession (27687) — if done for equinus. But spring ligament isn't ankle. Now, - Tenolysis — bundled if same tendon. Separate incision? g.**Read your payer policy.Many bundle it. Tread carefully.
5. Apply modifiers
- 59 or XS — separate structure, separate incision. Use when you have a distinct procedure not normally bundled.
- 51 — multiple procedures. Most payers auto-apply this on the second/third code. You don't always need to add it manually.
- 22 — increased procedural services. Rare. Only if documentation supports significantly more work (e.g., massive scarring, revision with graft, 3+ hours). Payers scrutinize this hard.
6. Match diagnosis codes
PTT dysfunction staging matters.
- **M21.4
6. Match diagnosis codes
The CPT codes are only part of the story. Practically speaking, the ICD‑10‑CM codes you attach must reflect the exact pathology and severity; otherwise, the claim is likely to be denied or reduced. Below is a quick reference for the most common PTT‑related diagnoses that should accompany the procedural codes.
| ICD‑10‑CM | Foot/Ankle Condition | Typical Coding Context |
|---|---|---|
| M21.Because of that, 6 | Pain in foot | When pain is the primary complaint and no specific tendon pathology is documented. On the flip side, 6** |
| **M79. g. | ||
| M21.4 | Chronic tendinosis, foot | Use when the note cites “chronic PTT tendinosis” or “degenerative tendon change. |
| **M79.In practice, ” | ||
| **M21. | ||
| M21.Think about it: , partial tear, enthesopathy). 6 | Other osteoarthrosis, foot | When a concomitant osteotomy (28300/28306) is done for biomechanical correction. |
| **M21. | ||
| **M21.That said, g. | ||
| M19.5 | Acute tendon rupture, foot | Pair with a direct repair (28200) or a free‑graft repair (28202). 8** |
Not the most exciting part, but easily the most useful That's the part that actually makes a difference..
Tip: Always confirm the primary diagnosis in the operative note. If the note lists “PTT rupture” but the ICD code is M19.6, the claim will likely be rejected for “lack of medical necessity.”
7. Final sanity check before submission
| Item | What to verify | Why it matters |
|---|---|---|
| Laterality | RT or LT? | |
| Surgical approach | Medial vs. | 59 modifier may be required if the approach is distinct. lateral incision? allograft? |
| Diagnosis‑procedureѓ alignment | Are the procedures justified by the ICD‑10 codes? Bilateral? | Some payers consider it unlisted; others bundle it with the PTT repair. |
| Documentation of graft | Harvested plantaris vs. | Determines 28200 vs. And |
| Modifiers | 59 (separate incision), 51 (multiple procedures), 22 (increased services) | Over‑use of modifiers can raise audit flags; under‑use can leave money on the table. |
| Bundled vs. Unbundled | Is the spring ligament repair truly separate? 28202. | Incorrect laterality can trigger denials or result in a single‑code claim. |
8. Payer‑specific nuances
| Payer | Key Points |
|---|---|
| Medicare (Part B) | 28202 is reimbursed at 100% of the national fee schedule; 28200 at 100%. The spring ligament repair is unbundled and should be coded 29999. And 51 modifier is auto‑applied for the second code. Consider this: |
| Commercial (Blue Cross, Aetna, etc. Because of that, ) | Many commercial plans bundle 28202 with 27691 if the tenolysis is on the same tendon. Use 59 if a second tendon is tenolized. Spring ligament repair is often unlisted, but some plans allow 28585 if documentation supports a ligament repair. Now, |
| Medicaid | State‑specific rules vary. Some states list spring ligament repair under 29999; others bundle it. Always check the state’s fee schedule. |
| Military/VA | VA’s fee schedule often mirrors Medicare but may have additional modifiers (e.g., XS for separate incision). |
