Closed treatment of a talus fracture without manipulation — stabilization using casting or splinting, no reduction performed.

Verified May 8, 2026 · 6 sources ↓

Medicare: $265.87
Work RVU: 2.16
Global, days: 90
Region: Foot & ankle

Drawn from CMSFastrvuAAPCFindacode

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm fracture is nondisplaced and closed — document this explicitly in the treatment note
State that no manipulation was performed; 'fracture reduced in cast' or similar language will trigger recode to 28435
Specify type of immobilization applied (short-leg cast, posterior splint, walking boot) and weight-bearing status
Include radiographic findings — at minimum the view(s), laterality, fracture location on the talus (body, neck, head, posterior process), and alignment
Document neurovascular status of the foot at the time of treatment
Record patient co-morbidities or circumstances that add complexity if billing modifier 22

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 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 6 cited references ↓

CPT 28430 covers closed (non-surgical) management of a talus fracture that does not require manipulation to achieve alignment. The talus sits at the apex of the ankle, articulating with the tibia, fibula, and calcaneus — making it critical to ankle stability and load transfer. When the fracture is nondisplaced and stable, treatment consists of immobilization, typically a short-leg cast or splint, without any attempt to reposition the fragment. No incision and no percutaneous fixation are involved.

This code carries a 90-day global period. All routine follow-up within that window — cast checks, cast changes, X-ray review tied to the fracture, and suture/staple removal if any minor wound was created — is bundled. If you see the patient for an unrelated problem during the global, append modifier 24 to the E/M. If you perform a distinct, unrelated procedure during the global, use modifier 79.

Don't confuse 28430 with adjacent codes: 28435 is closed treatment WITH manipulation; 28436 adds percutaneous skeletal fixation with manipulation; 28445 is open treatment. Selecting the wrong code is the most common audit trigger for talus fracture claims. Imaging obtained at the time of injury and the operative/treatment note must clearly state no manipulation was performed and confirm the fracture pattern (nondisplaced) to support 28430.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (2.16) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (7.96) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	2.16
Practice expense RVU	5.43
Malpractice RVU	0.37
Total RVU	7.96
Medicare national rate	$265.87
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	$265.87
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI P2) Ambulatory surgical center (freestanding)	$135.54

Common denial reasons

The recurring reasons claims for CPT 28430 get rejected.

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

Code mismatch with ICD-10: fracture diagnosis coded as displaced (S92.x with displacement qualifier) conflicts with 28430 (no manipulation) — payer edits flag this pairing
Missing laterality modifier (LT or RT) required by many payers for unilateral foot/ankle procedures
Same-day E/M billed without modifier 25 — the initial fracture assessment is bundled unless a separately documented and significant evaluation supports the additional charge
Global period violation: follow-up cast change or fracture check billed as a separate E/M without modifier 24 when the problem is related to the index fracture
Upcoding audit: documentation uses language suggesting the fracture was manipulated or that alignment was 'improved,' triggering recode to 28435 on review

Frequently asked questions

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

01What's the difference between 28430 and 28435?

28430 is closed treatment without manipulation — the fracture is nondisplaced and you apply immobilization only. 28435 is closed treatment with manipulation — you actively reduce the fracture before immobilizing. The distinction must be documented in the treatment note; 'fracture treated with cast' alone is insufficient to support either code.

02Do I need a modifier for laterality?

Yes. Most commercial payers and many MACs require LT or RT on foot and ankle fracture codes. Missing laterality is a clean-claim failure point — the claim edits on the front end, not on medical necessity review.

03Can I bill an E/M on the same day as 28430?

Only if the E/M represents a significant, separately documented service beyond the fracture work-up — for example, managing an acute unrelated problem at the same visit. Append modifier 25 to the E/M. An E/M solely for the fracture assessment is bundled into 28430.

04What ICD-10 codes pair correctly with 28430?

Use nondisplaced talus fracture codes from the S92.1x series (e.g., S92.101A for unspecified nondisplaced fracture of the right talus, initial encounter). Displaced fracture ICD-10 codes conflict with the no-manipulation definition of 28430 and will draw payer scrutiny.

05If the fracture requires open treatment later, how do I bill the subsequent procedure?

Use 28445 (open treatment of talus fracture) with modifier 58 — staged or related procedure during the global period of 28430. Modifier 78 applies only to unplanned returns to the OR for a complication. Planned conversion to open fixation is a 58.

06Can a single cast treating bilateral talus fractures be billed as two units of 28430?

Yes, bilateral fractures can each be reported — use LT and RT modifiers. However, per NCCI policy, one unit of service covers all fractures of the same bone treated with a single cast or splint on the same foot. Two separate feet, two separate line items.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the fracture location on the talus, displacement status from imaging, immobilization type applied, weight-bearing instructions, and an explicit statement that no manipulation was performed. That documentation directly defends 28430 against recode to 28435 and supports the nondisplaced fracture ICD-10 qualifier required to avoid CPT–diagnosis mismatch denials.

See how Mira captures CPT 28430 documentation