CPT 28055, in plain terms, covers Cutting of the nerve supply to the small intrinsic muscles of the foot. CPT 28055 is referenced in 4 tracked payer policy changes from UnitedHealthcare and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 28055 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 28055 on AAPC
UnitedHealthcare is removing a long list of CPT codes from the applicable-code list of its Outpatient Surgical Procedures site-of-service policy for Exchange plans, and it is also removing the link to the Manipulation Under Anesthesia policy. The change takes effect December 1, 2026. The source does not state a new billing requirement for the removed codes.
Effective December 1, 2026, UMR removes more than 500 CPT codes from its Outpatient Surgical Procedures - Site of Service medical policy for commercial plans, and it drops a reference link to the Manipulation Under Anesthesia policy. For those codes, UMR's site-of-service policy no longer applies, so the practice should update its internal UMR site-of-service and prior authorization lists before that date.
Effective December 1, 2026, UnitedHealthcare removes more than 500 CPT codes from its Outpatient Surgical Procedures - Site of Service medical policy for commercial plans, and it drops a reference link to the Manipulation Under Anesthesia policy. For those codes, the site-of-service policy no longer applies under this UnitedHealthcare commercial policy, so the practice should update its internal site-of-service and prior authorization lists before that date.
Aetna considers neurosurgical procedures medically necessary for refractory spasticity only when the member has good intrinsic lower extremity motor power but is limited in ambulation by spasticity, has the functional capacity and motivation to take part in post-operative rehabilitation, and has tried and failed non-surgical medical management including baclofen or other muscle relaxants. Aetna considers selective posterior rhizotomy experimental, investigational, or unproven when the member has concomitant dystonia or rigidity, profound lower extremity weakness where the spasticity helps the member stand, progressive neurological disorders, choreoathetosis or cerebellar ataxia, severe damage to the basal ganglia, or severe fixed joint deformities or scoliosis. Acupuncture, botulinum toxin, thalamic stimulation, cryoneurolysis, dry needling, extracorporeal shock wave therapy, mirror therapy, pulsed radiofrequency, transcranial direct current stimulation and several other techniques are considered experimental, investigational, or unproven because the effectiveness of these approaches has not been established.
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