Open surgical repair of a calcaneal fracture using an autogenous bone graft harvested from the iliac crest or another donor site, with internal fixation applied as needed.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,208.78
Total RVUs: 36.19
Global, days: 90
Region: Foot & ankle

Drawn from AAPCCMSSciencedirectFastrvu

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify that bone graft is autogenous (patient's own bone), not allograft or synthetic matrix — this is the coding pivot between 28420 and 28415
Document a separate incision over the iliac crest or named donor site, including irrigation and layered closure of the donor wound
Name the internal fixation hardware used (e.g., calcaneal plate, lag screws) or state explicitly that no hardware was applied
Describe fracture fragment mobilization, anatomic reduction, and graft packing into the defect site by name
Identify the surgical approach by name (e.g., lateral extensile, sinus tarsi) — operative notes that reference only 'standard approach' are audit flags
Record sural nerve identification and protection if performed, supporting complexity and reducing liability exposure

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 25 Significant separate E/M 51 Multiple procedures 57 Decision for surgery 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

28420 covers open treatment of a calcaneal (heel bone) fracture where the surgeon harvests the patient's own bone — typically from the iliac crest through a separate incision — and packs it into the fracture site to support healing. Internal fixation (screws, plates) is included when performed. The code bundles the graft harvest; you do not separately report the iliac crest harvest. This distinguishes 28420 from 28415, which is the appropriate code when allograft, demineralized bone matrix, or other synthetic material fills the defect instead of autogenous bone.

The 90-day global period covers the operative day, the day-before preoperative visit, and all routine post-op management through day 90. Fluoroscopic guidance used intraoperatively is bundled per NCCI — do not report it separately unless hard or electronic copies of the films are taken for the patient record with a separate and distinct radiologic interpretation. Document the donor site incision and closure explicitly in the operative note; auditors look for confirmation that the harvest was a distinct procedural step.

Site of service matters here. HOPD and ASC payment rates differ substantially (see the Site of Service comparison table). A ScienceDirect review of ACS-NSQIP data from 2014–2019 found that outpatient performance of 28420 does not carry excess 30-day complication risk versus inpatient, supporting ASC placement for appropriately selected patients.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	17.08
Practice expense RVU	15.48
Malpractice RVU	3.63
Total RVU	36.19
Medicare national rate	$1,208.78
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	$1,208.78
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$8,879.17

Common denial reasons

The recurring reasons claims for CPT 28420 get rejected.

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

Billing 28420 when allograft or demineralized bone matrix (e.g., Arthrex DBM) was used — payers will downcode to 28415
Separately reporting bone graft harvest alongside 28420 — harvest is bundled and will deny
Missing documentation of a separate donor-site incision, causing payers to treat the graft as same-site and reclassify to 28415
Reporting fluoroscopy guidance as a separate line item without hard or electronic film copies and a distinct radiology read
ICD-10 diagnosis code does not specify calcaneus as the fracture site, triggering a CPT-to-diagnosis mismatch denial

Frequently asked questions

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

01What is the difference between 28415 and 28420?

28415 is open calcaneal fracture repair with or without internal fixation. 28420 adds autogenous bone graft harvested from the patient's own body through a separate incision. Use 28415 when the surgeon uses allograft, demineralized bone matrix, or synthetic bone substitute — those materials do not qualify for 28420.

02Can I separately report the iliac crest bone graft harvest with 28420?

No. The harvest is bundled into 28420. Billing a separate graft harvest code alongside 28420 will deny. The code descriptor explicitly states it includes obtaining the graft.

03Is fluoroscopy separately billable during 28420?

Generally no. Per NCCI and AAOS guidance, intraoperative fluoroscopy is included in the global package. You can report it separately only if hard or electronic film copies are taken for the patient record and a distinct radiologic interpretation is documented.

04What global period applies to 28420?

90-day global. That covers the day-before preoperative visit, the surgery, and all routine post-op care through day 90. Use modifier 24 for unrelated E/M visits and modifier 79 for unrelated procedures performed during the global window.

05Can 28420 be performed in an ASC?

Yes. An ACS-NSQIP review of 28420 cases from 2014–2019 found no excess 30-day complication risk in the outpatient setting for appropriately selected patients. ASC payment is lower than HOPD — see the Site of Service comparison table on this page.

06What modifier applies if the surgeon returns to the OR for a complication related to the original 28420?

Modifier 78 — unplanned return to the OR for a related procedure during the postoperative period. Use modifier 79 if the return procedure is unrelated to the original calcaneal repair.

07What ICD-10 codes are typically paired with 28420?

Codes from the S92.0x series (fracture of calcaneus) are the primary pairing. Laterality matters — specify left, right, or bilateral. Payers flag claims where the ICD-10 does not anatomically match calcaneus as the fracture site.

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 donor site name (iliac crest or alternative), confirmation of autogenous versus allograft material, the separate incision and closure of the harvest site, approach name, hardware applied, and explicit fracture reduction language — all from surgeon dictation. That prevents the most common 28420 downcode: a payer reclassifying to 28415 because the operative note never distinguished autogenous harvest from synthetic graft fill.

See how Mira captures CPT 28420 documentation