Billing correctly for neuroma intermetatarsal operations requires a degree of accuracy that extends beyond selecting the appropriate CPT code. It also requires complete documentation, careful use of modifiers, and knowledge of each payer’s requirements. This disease, called Morton’s neuroma in popular parlance, is a cause of nerve irritation between the bones of the foot, and this situation has created a specific coding problem that could have a significant impact on the practices’ incomes. Mastering the intricacies of CPT 28080 and related procedural codes ensures clean claims and fewer denials.
Primary CPT Code for Neuroma Intermetatarsal Excision
CPT 28080:
CPT 28080 – Excision, interdigital (Morton) neuroma, each remains the definitive code for neuroma intermetatarsal excision. This code specifically describes the surgical removal of an interdigital neuroma and should be your default choice.
Key coding parameters:
- Report once per neuroma excised
- 90-day global surgical period applies
- Multiple neuromas require modifier -59 for each additional lesion
- Both facility and non-facility settings are accepted
Documentation requirements for CPT 28080:
- Precise interspace identification (second, third, or fourth interspace)
- Clear laterality designation
- Measured neuroma dimensions post-excision
- Surgical approach description (dorsal vs. plantar incision)
- Pathology specimen confirmation
Common coding error: Using generic nerve excision codes (64774 or 64784) instead of CPT 28080 results in improper reimbursement and increased audit risk. These codes describe peripheral nerve neuromas in other anatomical locations and don’t accurately reflect intermetatarsal neuroma surgery.
Conservative Treatment CPT Codes
Before surgical intervention for neuroma intermetatarsal, payers require documented conservative management attempts. These codes lay the foundation for your medical necessity.
Injection Procedures
CPT 64455 – Injection(s); anesthetic agent and/or steroid, plantar common digital nerve(s)
This code covers both diagnostic and therapeutic injections for neuroma intermetatarsal treatment:
- Payers typically authorize 3-4 injections annually per anatomical site
- Document medication type, concentration, and volume administered
- Record patient-reported pain relief percentage and duration
- Note injection technique: ultrasound-guided versus anatomical landmark-based
Alternative: CPT 20550 may be accepted by some payers, though 64455 provides greater anatomical specificity.
Diagnostic Imaging Codes
Establishing a neuroma intermetatarsal diagnosis requires imaging documentation:
- CPT 76882 – Extremity ultrasound for neuroma visualization and measurement
- CPT 73630 – Complete foot radiographs (minimum 3 views) to exclude osseous pathology
- CPT 73718 – Foot MRI without contrast for definitive soft tissue characterization
Clinical tip: MRI authorization often requires a failed ultrasound or inconclusive findings. Document the clinical reasoning in your imaging orders.
Critical Modifier Application
Laterality Modifiers (Mandatory)
Missing laterality modifiers represent the leading cause of neuroma intermetatarsal claim denials.
Required modifiers:
- -RT (Right side) for right foot procedures
- -LT (Left side) for left foot procedures
- -50 (Bilateral) when performing identical procedures on both feet during one operative session
Payer variation: Some carriers prefer separate claim lines with -RT and -LT rather than modifier -50. Verify preference before billing bilateral cases.
Procedure-Specific Modifiers
Modifier -59 (Distinct Procedural Service)
Essential when excising multiple neuroma intermetatarsal lesions during one surgical encounter:
- Append to the second and subsequent neuroma excisions
- Document anatomically distinct interspaces in the operative report
- Some payers accept -XS (Separate Structure) as a more specific alternative
Modifier -25 (Significant, Separately Identifiable E/M)
Apply when providing an evaluation beyond the injection or minor procedure:
- Requires separate documentation of clinical decision-making
- Medical necessity must extend beyond the planned procedure
- Cannot simply restate injection indications
ICD-10 Diagnosis Coding Specificity
Primary Diagnosis for Neuroma Intermetatarsal
G57.6 – Lesion of plantar nerve (Morton’s metatarsalgia)
Specificity requirements:
- G57.61 – Right lower limb
- G57.62 – Left lower limb
- G57.63 – Bilateral lower limbs
Never use G57.60 (unspecified) when laterality is documented. This triggers automatic payer review and potential denial.
Supporting Diagnoses
Strengthen medical necessity with symptom-specific codes:
- M79.671/M79.672 – Localized foot pain with laterality
- R20.2 – Paresthesia of skin (numbness, tingling)
- M25.571/M25.572 – Pain in ankle and foot joints
Documentation Standards That Prevent Denials
Preoperative Documentation Checklist
Medical necessity for neuroma intermetatarsal surgery hinges on documented conservative treatment failure spanning 3-6 months:
Required conservative interventions:
- Orthotic devices or metatarsal pads (minimum 6-8 weeks trial)
- Shoe modification recommendations with compliance documentation
- NSAID therapy or alternative pain management
- Corticosteroid injection series (typically 2-3 attempts with response tracking)
- Activity modification counseling
- Physical therapy when clinically appropriate
Clinical examination documentation:
- Positive Mulder’s sign with palpable click
- Specific interspace tenderness reproduction
- Sensory examination findings in the affected web space
- Pain radiation pattern to adjacent toes
- Functional limitation impact on ambulation
Operative Report Essential Elements
Your surgical documentation must provide clear justification for CPT 28080:
- Anatomical precision – “Neuroma intermetatarsal located in the third interspace between the third and fourth metatarsal heads, right foot”
- Approach description – “Longitudinal dorsal incision over the third intermetatarsal space”
- Dissection details – “Deep dissection through the intermetatarsal ligament exposed the neuroma.”
- Neuroma characteristics – “Fusiform enlargement of the plantar digital nerve measuring 9mm x 6mm x 5mm”
- Excision technique – “Sharp transection of the nerve proximal to the metatarsal heads with complete neuroma removal”
- Specimen handling – “Specimen labeled and submitted to pathology for histopathological confirmation”
Common Billing Errors and Solutions
| Billing Error | Financial Impact | Prevention Strategy |
| Omitted laterality modifiers | Claim denial, 30-60 day delay | Implement an automated coding checklist |
| Insufficient conservative care documentation | Medical necessity denial | Template-based documentation with date tracking |
| Incorrect CPT selection | 20-40% underpayment | Staff education on CPT 28080 specificity |
| Missing modifier -59 for multiple neuromas | Bundling of the second neuroma | The operative report template includes distinct anatomical documentation |
| Inadequate operative detail | Audit risk, potential recoupment | Surgeon education on the seven essential documentation elements |
Payer-Specific Requirements
Medicare Coverage Criteria
Medicare Administrative Contractors enforce specific neuroma intermetatarsal coverage requirements:
- Minimum 3-month conservative treatment documentation
- Local Coverage Determination (LCD) compliance verification
- Advanced Beneficiary Notice (ABN) when coverage is uncertain
- 90-day global period affects related E/M visit billing
Commercial Payer Variations
Prior authorization protocols:
- Most carriers require pre-surgical authorization for CPT 28080
- Authorization requests should include imaging reports and injection records
- Some payers mandate peer-to-peer physician review
- Verify in-network pathology laboratory requirements
Treatment protocol differences:
- Required number of injection attempts (ranges from 2-4)
- Acceptable conservative treatment duration (3-6 months)
- Imaging requirements (ultrasound sufficient vs. MRI required)
- Bilateral procedure coverage limitations
Workers’ Compensation Considerations
Occupational neuroma intermetatarsal cases require additional documentation:
- Causation statement linking the condition to work activities
- State-specific utilization review approval
- Compliance with jurisdiction treatment guidelines
- Pre-authorization timelines vary (3-30 business days)
Reimbursement Optimization Strategies
Pre-Surgical Verification
Financial clearance checklist:
- Confirm active insurance coverage and benefits
- Obtain prior authorization with reference number documentation
- Verify deductible and coinsurance obligations
- Check for any step-therapy requirements
- Confirm surgeon and facility network status
Claim Submission Best Practices
For clean first-pass claims:
- Use CPT 28080 exclusively for neuroma intermetatarsal excision
- Apply appropriate laterality modifier on every claim line
- Link most specific ICD-10 code with laterality designation
- Attach operative report when filing exceeds standard complexity
- Include pathology report if available at submission time
Typical Reimbursement Ranges
Medicare Physician Fee Schedule (2025 estimates):
- CPT 28080: $520-$680 (facility), $850-$1,050 (non-facility)
- CPT 64455: $95-$140 per injection
- CPT 76882: $70-$95 diagnostic ultrasound
Conclusion
The reimbursement of intermetatarsal neuroma procedures very much depends on the three critical aspects: first selection of CPT code which is 28080 as your main code, thorough documentation of the treatment that has failed, and the ever so consistent application of laterality modifiers. The medical difficulties that come with intermetatarsal neuromas deserve the right and medicare support when back up with proper documentation showing the medical need.
If providers adopt systematic documentation, double-check payer requirements prior to surgery, and avoid the five common billing errors mentioned, they will simultaneously improve their revenue cycle performance and remain compliant. Regularly checking the updated CPT guidelines, Medicare LCDs, and commercial payer medical policies ensures billing accuracy is a continuous process of adaptation to changing requirements.
Take your neuroma intermetatarsal reimbursement to the max with professional medical billing support. Get in touch with our expert team now and fight the denials and make your revenue cycle work efficiently.
FAQs
Q: What is the primary CPT code for neuroma intermetatarsal excision?
A: CPT 28080 is the specific code for excision of interdigital (Morton) neuroma and should be used instead of generic nerve excision codes.
Q: How many conservative treatment attempts are required before neuroma intermetatarsal surgery?
A: Most payers require 3-6 months of documented conservative care, including orthotics, injections (2-3 attempts), and activity modifications.
Q: Which modifiers are mandatory for neuroma intermetatarsal billing?
A: Laterality modifiers (-RT for right, -LT for left, or -50 for bilateral) are required on every claim to prevent automatic denials.
Q: What ICD-10 code should be used for neuroma intermetatarsal diagnosis?
A: Use G57.61 (right), G57.62 (left), or G57.63 (bilateral) – never use G57.60 (unspecified) when laterality is known.