Open surgical repair of a calcaneal (heel bone) fracture, with internal fixation applied when needed to stabilize bone fragments.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,048.79
Total RVUs: 31.4
Global, days: 90
Region: Foot & ankle

Drawn from CMSMedicare ProcedureAAPCFindACode CPT

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm direct visualization of the fracture site — document that the fracture was accessed via open incision, not percutaneous approach under fluoroscopy.
Specify the type of internal fixation used (plates, screws, pins, IM nail) or explicitly document that fixation was not performed.
Document fracture pattern, displacement status, and imaging findings (X-ray, CT) that support open surgical intervention.
If bone graft was used, identify graft source (autograft with harvest site, cadaveric allograft, or synthetic bone matrix) — harvest of iliac or other autogenous bone graft through a separate incision escalates to 28420.
Note whether fracture was open or closed, and document any soft-tissue injury, compartment syndrome, or concurrent foot fractures requiring separate treatment.
Record intraoperative fluoroscopy use; note whether hard or electronic copies of images were retained with a separate radiology interpretation if seeking to bill imaging separately.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 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 28415 covers open treatment of a calcaneal fracture — the surgeon makes a direct incision to visualize the fracture site, reduces the displaced fragments, and applies internal fixation (plates, screws, or pins) when needed. Direct visualization is what separates this code from 28406, which uses a percutaneous approach under fluoroscopic guidance without opening the fracture site. Intraoperative fluoroscopy is included in the global package per NCCI guidelines and is not separately reportable unless hard or electronic copies are retained with a distinct radiology read.

Code 28415 sits in a family of calcaneal fracture codes: 28400 (closed, no manipulation), 28405 (closed, with manipulation), 28406 (percutaneous fixation with manipulation), 28415 (open, fixation when performed), and 28420 (open with autogenous iliac or other primary bone graft). Use 28420 only when the surgeon harvests bone through a separate incision — cadaveric or synthetic bone matrix stays under 28415. The code description was updated effective January 1, 2026 per the CMS Integrated Outpatient Code Editor.

The 90-day global period covers the day-before visit, the surgery, and all routine postoperative care through day 90. E/M services on the day of surgery require modifier 57 when the decision to operate was made that encounter. Unplanned return trips to the OR for a related complication within the global period use modifier 78; unrelated procedures in the same window use modifier 79.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	15.79
Practice expense RVU	12.9
Malpractice RVU	2.71
Total RVU	31.4
Medicare national rate	$1,048.79
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	$1,048.79
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,871.04

Common denial reasons

The recurring reasons claims for CPT 28415 get rejected.

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

Approach mismatch: operative note describes fluoroscopic guidance without open incision, which maps to 28406, not 28415.
Upcoding to 28420 denied when no autogenous graft harvest through separate incision is documented — cadaveric or synthetic graft stays under 28415.
Global period conflicts: E/M or follow-up visit billed within the 90-day global without modifier 24 (unrelated) or 57 (decision for surgery).
Missing or vague laterality: claim submitted without LT or RT modifier when payer requires it, triggering automatic rejection.
Bundling with percutaneous fixation code 28406 when only one calcaneal fracture was treated through a single incision.

Frequently asked questions

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

01What is the difference between 28415 and 28406?

The approach. Code 28406 is percutaneous fixation — the surgeon places hardware across the fracture site under fluoroscopic guidance without directly visualizing the bone. Code 28415 requires an open incision and direct visualization of the fracture fragments. If the operative note describes C-arm guidance without an open incision, 28406 is correct.

02When does 28415 escalate to 28420?

Only when the surgeon harvests autogenous bone (iliac crest or other donor site) through a separate incision and places it at the fracture site. Cadaveric allograft and synthetic bone matrix (bone matrix putty, DBM) do not trigger 28420 — those cases stay under 28415.

03Is fluoroscopy separately billable with 28415?

Not routinely. Per NCCI guidelines and AAOS guidance, intraoperative fluoroscopic guidance is included in the global package. It becomes separately reportable only when hard or electronic copies of the images are retained and there is a distinct, documented radiology interpretation.

04Can you bill two calcaneal fracture codes if there are multiple fracture fragments?

Generally no for fragments accessed through the same incision — NCCI bundles those. Separate coding may be supportable only if distinctly separate posterior calcaneal fractures require separate incisions. Check individual payer contracts; this is not a uniform rule across payers.

05What modifier applies to an E/M on the same day as 28415?

Modifier 57 when the E/M visit is the encounter where the decision to perform surgery was made. Use modifier 25 only if the E/M was a significant, separately identifiable service unrelated to the fracture being treated that day.

06What modifier applies if the surgeon returns to the OR within the 90-day global for a wound complication from the original calcaneal repair?

Modifier 78 — unplanned return to the OR for a procedure related to the original surgery during the global period. Do not use modifier 79, which is reserved for unrelated procedures performed during the global window.

07Does 28415 carry a 90-day global period?

Yes. The 90-day global covers the day-before preoperative visit, the surgery itself, and all routine postoperative care through day 90. Anything billed within that window that is unrelated to the calcaneal repair needs modifier 24 on the E/M or modifier 79 on a surgical procedure.

Sources & references

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

01CMS Physician Fee Schedule 2026
02CMS January 2026 Integrated Outpatient Code Editor (I/OCE): https://www.cms.gov/files/document/r13575cp.pdf
03Medicare Procedure Price Lookup 2026 — Code 28415: https://www.medicare.gov/procedure-price-lookup/cost/28415
04AAPC Orthopedic Coding Alert: Get Anatomy, Procedure Type Right for These Foot Fractures (2019): https://www.aapc.com/codes/coding-newsletters/my-orthopedic-coding-alert/surgery-get-anatomy-procedure-type-right-for-these-foot-fractures-160619-article
05AAPC Orthopedic Coding Alert: Step Up Your Heel Bone Fracture Coding Skills: https://www.aapc.com/codes/coding-newsletters/my-orthopedic-coding-alert/coding-tips-step-up-your-heel-bone-fracture-coding-skills-133137-article
06FindACode CPT 28415: https://www.findacode.com/cpt/28415-cpt-code.html

Mira AI Scribe

Mira's AI scribe captures the surgical approach (open incision with direct visualization), specific fixation hardware applied, graft material and source if used, laterality, fracture classification, and whether intraoperative imaging films were retained. That detail prevents the two most common 28415 denials: approach mismatch with 28406 and inappropriate escalation to 28420 when no separate autogenous graft harvest occurred.

See how Mira captures CPT 28415 documentation