Percutaneous skeletal fixation of a calcaneal fracture with manipulation, performed without direct visualization of fracture fragments, using imaging guidance for hardware placement.

Verified May 8, 2026 · 6 sources ↓

Medicare: $549.44
Total RVUs: 16.45
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCBedrockbillingFindacodeEmedny

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify percutaneous approach explicitly — note absence of direct fracture fragment visualization
Document C-arm or fluoroscopic imaging use for pin/screw placement and fracture reduction confirmation
Describe manipulation technique and final reduction achieved, including post-reduction alignment
Record hardware type, size, and placement site (e.g., Steinmann pin, cannulated screw, insertion point)
Include ICD-10 fracture code specifying laterality, displacement status, and encounter type (initial, subsequent, sequela)
Note whether films/hard copies were archived for the patient record if fluoroscopy is to be separately reported

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 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 28406 describes percutaneous skeletal fixation of a calcaneal (heel bone) fracture with manipulation. The defining characteristic is the approach: fracture fragments are not directly visualized. Instead, the surgeon manipulates the fracture and places fixation hardware — typically Steinmann pins or screws — percutaneously, navigating with fluoroscopic (C-arm) imaging. Fluoroscopic guidance is included in the global package per AAOS and NCCI guidelines and is not separately reportable unless hard or electronic film copies are taken for the patient file with a distinct radiology reading.

The critical code-selection decision is approach. Use 28406 for percutaneous fixation without direct visualization. Use 28415 when the fracture is treated through an open incision with direct visualization of fragments, including internal fixation. An intramedullary rod is classified as open treatment regardless of incision size. Misidentifying an open approach as percutaneous — or vice versa — is the most common audit trigger for this code family.

28406 carries a 90-day global period. All routine follow-up care through day 90 is bundled. Bill new, unrelated E/M services with modifier 24; staged or related procedures within the global with modifier 78 or 79 as appropriate.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.4
Practice expense RVU	8.84
Malpractice RVU	1.21
Total RVU	16.45
Medicare national rate	$549.44
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	$549.44
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI G2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 28406 get rejected.

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

Operative note says 'standard approach' without explicitly confirming percutaneous, no-direct-visualization technique — prompts medical review or downcode
Fluoroscopic guidance billed separately (e.g., 77002) when no distinct hard-copy radiology read is documented — bundled under NCCI
Code submitted as 28415 (open) when documentation actually supports percutaneous approach, or vice versa — approach mismatch triggers payer audit
Missing laterality modifier (LT or RT) — required by most payers and many state Medicaid programs including New York Medicaid
Routine post-op visit billed without modifier 24 during the 90-day global period, resulting in denial

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What separates 28406 from 28415?

Approach. 28406 is percutaneous — no direct visualization of fracture fragments, reduction and hardware placement confirmed under fluoroscopy. 28415 is open — direct visualization with incision. An IM rod is open treatment regardless of skin incision size.

02Can fluoroscopic guidance be billed separately with 28406?

Only if hard or electronic copies of the films are taken for the patient record and a separate, distinct radiology interpretation is documented. Without that, fluoroscopy is bundled into the global package per AAOS and NCCI guidelines.

03Is a laterality modifier required?

Yes. Append LT or RT on every claim. Most commercial payers and Medicare contractors require it, and New York Medicaid explicitly requires laterality modifiers for unilateral foot and ankle procedures.

04What is the global period for 28406?

90 days. The day of surgery, the day-before pre-op visit, and all routine post-op care through day 90 are bundled. Unrelated E/M visits in that window need modifier 24. A staged or related return procedure needs modifier 78.

05When is modifier 22 appropriate with 28406?

When the work was substantially greater than typical — for example, severely comminuted fracture requiring extended reduction time or unusual complexity. Document the specific factors that increased work; payers will request chart notes before paying the upcharge.

06Can 28406 be billed bilaterally if both heels are treated in the same session?

Yes. Report the code twice with LT and RT modifiers, or append modifier 50 per payer preference. Bilateral calcaneal fractures are uncommon but do occur in fall and axial-load injuries — document each side's procedure separately in the operative note.

07Is an assistant surgeon billable with 28406?

CMS allows assistant surgeon billing for this code. Bill the assistant with modifier 80 (physician assistant surgeon) or AS (PA, NP, or CNS acting as assistant). Confirm the operative note identifies the assistant and their role.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the approach (percutaneous, no direct fragment visualization), fluoroscopy use and whether film copies were archived, hardware type and placement, and the final reduction achieved. That documentation prevents the two most common denials for this code: approach mismatch with 28415 and improper separate billing of fluoroscopic guidance.

See how Mira captures CPT 28406 documentation