Closed reduction of a displaced talus fracture by manual manipulation, without surgical incision or percutaneous fixation.

Verified May 8, 2026 · 8 sources ↓

Medicare: $413.84
Work RVU: 3.45
Global, days: 90
Region: Foot & ankle

Drawn from CMSCodingintelAaomsAbosAAPC

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Pre-procedure imaging (X-ray or CT) documenting fracture type, displacement, and alignment
Explicit documentation that manipulation was performed — describe the technique and direction of force applied
Post-reduction imaging confirming alignment achieved
Immobilization method applied (short-leg cast, posterior splint, etc.) with position specified
Neurovascular status of the foot documented before and after reduction
Clinical rationale for closed versus open treatment
Mechanism of injury and injury date to support medical necessity and ICD-10 coding specificity

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 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 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 8 cited references ↓

CPT 28435 covers closed treatment of a talus fracture that requires hands-on manipulation to realign the bone. The talus is the keystone of the ankle mortise — it bears the entire body weight load transmitted from tibia to foot — so accurate reduction matters. The physician applies controlled force to restore alignment, confirmed by fluoroscopy or plain films, then immobilizes the foot in a cast or splint. No skin incision is made, and no hardware is placed; if percutaneous pins are added, step up to 28436.

The 90-day global period applies. That window covers the manipulation itself, the cast or splint application on the same day, and all routine follow-up through day 90 — including cast changes, repeat imaging to confirm alignment, and suture or staple removal if any minor wound care is needed. Bill separately only for services that are clearly outside routine fracture management (e.g., a new injury, a distinct complication requiring return to OR).

Talus fractures are typically high-energy injuries — motor vehicle accidents, falls from height — so the clinical picture often involves polytrauma. When you're treating concurrent fractures at separate anatomic sites during the same encounter, use modifier 59 or an X-modifier to bypass NCCI PTP edits, backed by documentation that each fracture was addressed distinctly. If the manipulation is significantly more complex than typical (comminution, repeated attempts, neurovascular monitoring), modifier 22 is available with a supporting narrative.

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 (3.45) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (12.39) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	3.45
Practice expense RVU	8.21
Malpractice RVU	0.73
Total RVU	12.39
Medicare national rate	$413.84
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	$413.84
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 28435 get rejected.

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

Missing post-reduction imaging in the note — payers flag manipulation claims without documented confirmation of reduction
ICD-10 code specificity mismatch — talus fracture codes require laterality and initial vs. subsequent encounter designation (S92.1xx with correct 7th character)
Global period overlap — follow-up E/M billed within 90 days without modifier 24 when unrelated to the fracture
Upcoding to 28436 or 28445 when no hardware was placed and no incision was made
Bilateral modifier 50 applied without payer authorization — some payers require prior authorization or restrict bilateral talus fracture billing

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01When does 28435 step up to 28436 or 28445?

Use 28436 when percutaneous pins or screws are placed to maintain reduction — even if no formal incision is made. Use 28445 when open reduction with or without internal fixation is performed through a surgical incision. If you manipulate and cast only, 28435 is correct.

02Can you bill for the cast application separately on the same day as 28435?

No. Casting and splinting applied on the same day as definitive fracture treatment are included in the global surgical package for 28435. Bill the cast supply (A6000-series HCPCS or Q-codes) separately if payer policy allows, but not the application service.

03What ICD-10 codes map to 28435?

Lead with S92.1xx-series codes for talus fractures (displaced or nondisplaced, body, neck, posterior process, dome), with the 7th character A for initial encounter when manipulation is first performed. The 7th character matters — payers will deny subsequent-encounter codes (D, G, K, P, S) billed with an active procedure like manipulation.

04Is modifier 50 valid for bilateral talus fractures treated at the same session?

Bilateral talus fractures at one session are rare but do occur in high-energy trauma. CMS allows modifier 50 for 28435 when both sides are genuinely treated. Check individual payer policy — some commercial payers require separate line items with LT and RT instead of a single line with 50.

05How do you bill an E/M during the 90-day global period if the patient presents with a new problem?

Append modifier 24 to the E/M code and document clearly that the visit was for a problem unrelated to the talus fracture. Modifier 24 without supporting documentation — a note that actually addresses only the fracture follow-up — is a common audit finding.

06Can modifier 22 be used if the reduction was unusually difficult?

Yes. If the fracture was severely comminuted, multiple reduction attempts were required, or the procedure took substantially longer than typical, modifier 22 is defensible. Attach a written narrative quantifying the extra work — time, attempts, complexity. Without it, most payers will not honor the upward payment adjustment.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the manipulation technique, number of reduction attempts, fluoroscopic or radiographic confirmation of alignment, immobilization type and position, and pre- and post-reduction neurovascular exam from the physician's dictation. This prevents the most common denial trigger for 28435: a note that documents a fracture and a cast but never explicitly states that manipulation was performed.

See how Mira captures CPT 28435 documentation