Closed treatment of a calcaneal (heel bone) fracture with manual reduction to realign bone fragments, performed without surgical incision.

Verified May 8, 2026 · 5 sources ↓

Medicare: $502.02
Total RVUs: 15.03
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCFindacodeNIH

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 5 cited references ↓

Pre-procedure imaging (X-ray or CT) confirming calcaneal fracture with displacement requiring manipulation
Explicit documentation that manipulation was performed — not simply applied and immobilized
Description of the reduction technique and confirmation of post-reduction alignment (fluoroscopy or post-reduction X-ray findings)
Type of immobilization applied after reduction (short leg cast, splint, boot) and weight-bearing status assigned
Laterality clearly stated (left, right, or bilateral) to support LT/RT or modifier 50 appended to the claim
Clinical rationale distinguishing this case from 28400 (no manipulation) — fracture displacement or angulation must be documented

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 28405 describes closed reduction of a displaced calcaneal fracture — the physician manually manipulates the heel bone fragments back into anatomic alignment without opening the skin. This is the step up from 28400 (closed treatment without manipulation), used when the fracture pattern requires hands-on reduction rather than simple immobilization. Imaging guidance, typically fluoroscopy, is used intraoperatively to confirm reduction quality before casting or splinting.

The calcaneus is the largest tarsal bone and bears the full axial load of the body. Fractures here — most commonly from axial impact (falls from height, motor vehicle accidents) — frequently involve the subtalar joint and require precise reduction to restore hindfoot mechanics. Documentation must reflect the displaced nature of the fracture and the clinical decision to manipulate rather than cast in situ.

This code carries a 90-day global period. All routine post-reduction visits, cast changes, and progress X-ray interpretations are bundled through day 90. Any E/M service unrelated to the fracture care during that window requires modifier 24. If the patient ultimately requires open reduction during the global period due to failed closed reduction, report the open procedure with modifier 58 (staged/related procedure).

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	4.62
Practice expense RVU	9.41
Malpractice RVU	1
Total RVU	15.03
Medicare national rate	$502.02
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$502.02
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI A2) Ambulatory surgical center (freestanding)	$135.54

Common denial reasons

The recurring reasons claims for CPT 28405 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Billed as 28405 but documentation only supports 28400 — operative note lacks description of active manipulation
Missing laterality modifier (LT or RT) causing claim rejection at payer edit level
E/M visit during the 90-day global billed without modifier 24 for unrelated diagnosis, denied as bundled
ICD-10 diagnosis code does not specify displaced fracture, creating mismatch with a manipulation code
Bilateral calcaneal reduction billed as two units without modifier 50, flagged by MUE edits

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What's the difference between 28400 and 28405?

28400 is closed treatment without manipulation — fracture is immobilized in its current position. 28405 requires active manual reduction to realign displaced fragments. If your note doesn't describe the act of manipulation, expect a downcode to 28400 on audit.

02Do I need a modifier for a unilateral calcaneal reduction?

Yes. Append LT or RT to every foot/ankle fracture code. Many payers edit on laterality, and missing it is a common clean-claim failure even when the clinical documentation is solid.

03What happens if closed reduction fails and I take the patient to the OR for open fixation during the global?

Bill the open reduction code (28415 or 28420 depending on approach) with modifier 58 — staged or related procedure. Modifier 58 signals a planned return or progression of care, which reopens a new global period from the date of the open procedure.

04Is fluoroscopy separately billable with 28405?

Generally no for the professional component when the physician performs the reduction. Fluoroscopy used for guidance during closed reduction is typically considered integral to the service. Confirm with your MAC, as facility billing rules differ.

05Can I bill an E/M visit on the same day as the closed reduction?

Only with modifier 25 if the E/M represents a separate, significant evaluation beyond the decision to treat the fracture. If the visit is solely the fracture evaluation leading directly to reduction, it's bundled into 28405.

06Does the 90-day global include cast changes and follow-up X-ray interpretation?

Yes. Cast changes, routine dressing changes, post-reduction X-ray interpretation, and standard follow-up visits are all bundled through day 90. Bill separately only for services clearly unrelated to the calcaneal fracture, and append modifier 24 to those E/M visits.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

01CMS Physician Fee Schedule 2026
02
aapc.com
https://www.aapc.com/codes/cpt-codes/28405
03
findacode.com
https://www.findacode.com/cpt/28405-cpt-code.html
04
vsac.nlm.nih.gov
https://vsac.nlm.nih.gov/context/cs/codesystem/CPT/version/2024/code/28405/info
05
cms.gov
https://www.cms.gov/files/document/r12052cp.pdf

Mira AI Scribe

Mira's AI scribe captures the fracture displacement description from pre-op imaging, the manipulation technique dictated intraoperatively, post-reduction alignment findings, and the immobilization method applied — all in a single operative note pass. That documentation chain is what separates a clean 28405 claim from a downcode to 28400 on audit.

See how Mira captures CPT 28405 documentation