Open surgical treatment of a talus fracture, with internal or external fixation performed when indicated.

Verified May 8, 2026 · 6 sources ↓

Medicare: $976.31
Total RVUs: 29.23
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCPodiatrymAbos

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Mechanism of injury documented (high-energy trauma, fall from height, MVA)
Fracture location and displacement confirmed on imaging (CT or X-ray) with report in record
Operative note specifies surgical approach by name (e.g., anteromedial, anterolateral, medial malleolar osteotomy approach) — 'standard approach' is an audit flag
Internal fixation type, size, and placement documented if hardware used
Intraoperative fluoroscopy or imaging findings noted when applicable
Neurovascular status documented pre- and post-operatively
Separate documentation for any debridement reported beyond the surgical approach (to support 11010–11012 if billed)

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 74 Discontinued post-anesthesia 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 ↓

CPT 28445 covers open treatment of a talus fracture — the second-largest tarsal bone and the only bone in the foot that articulates with the tibia and fibula. Because the talus bears the full weight of the body and has a notoriously tenuous blood supply, these fractures demand open reduction when displacement is significant. Internal fixation (screws, plates) is included in the code and not separately reported. The 90-day global period absorbs all routine postoperative management through day 90.

Talus fractures almost always result from high-energy trauma — motor vehicle accidents, falls from height, axial loading. When the surgeon performs a medial malleolar osteotomy to access the talar body, that osteotomy is considered part of the surgical approach and is not separately reportable. Bone graft substitutes used to fill voids are also bundled; no separate graft code is added. Excisional debridement (CPT 11010–11012) can be separately reported only when documentation clearly supports it as beyond routine wound care — NCCI Chapter I limits bundled debridement to 'simple' debridement inherent to the approach.

If a concurrent calcaneal or other tarsal fracture is treated in the same session, payer rules on separate reporting vary. NCCI guidelines indicate that treating one fracture without manipulation while treating another is generally not separately billable, but individual payer contracts can differ — verify before appending modifier 59. When a significant, separately identifiable E/M service is documented on the same day as the surgery decision, append modifier 57 (decision for surgery), not modifier 25.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	15.37
Practice expense RVU	11.08
Malpractice RVU	2.78
Total RVU	29.23
Medicare national rate	$976.31
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	$976.31
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,701.39

Common denial reasons

The recurring reasons claims for CPT 28445 get rejected.

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

Operative note uses generic approach language instead of naming the specific surgical approach, triggering medical necessity review
Medial malleolar osteotomy billed separately when it was the access approach — bundled per NCCI
Bone graft substitute billed as a separate supply code without payer-specific authorization
Concurrent calcaneal or tarsal fracture repair billed without confirming payer's separate-procedure policy, leading to NCCI bundling denial
E/M service on the same day as surgical decision billed with modifier 25 instead of modifier 57

Frequently asked questions

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

01Is internal fixation included in 28445 or billed separately?

Internal fixation is included. The code description covers open treatment with internal fixation when performed — you don't add a separate hardware placement code.

02The surgeon did a medial malleolar osteotomy to reach the talar body. Can that be billed separately?

No. Medial malleolar osteotomy used as a surgical approach to access the talar body is considered inherent to the procedure. NCCI Chapter I bundles surgical access maneuvers into the primary code. Don't report it separately.

03Can I report a bone graft separately when it's used to fill a talar defect during 28445?

Synthetic or allograft bone graft material is generally bundled. Autogenous iliac crest graft may support a separate graft harvest code, but verify with the specific payer — there's no universal rule permitting it.

04The surgeon also treated a calcaneal fracture in the same session. How do I bill both?

This is payer-dependent. NCCI guidance indicates that treating one fracture without manipulation alongside another is generally not separately reportable, but individual contracts vary. Pull the payer contract before appending modifier 59, and document each fracture's treatment distinctly in the operative note.

05Which modifier goes on an E/M service the day the surgeon decides to operate on a talus fracture?

Use modifier 57. The decision for major surgery (90-day global) made on the day of or the day before surgery requires modifier 57, not modifier 25. Modifier 25 is for minor procedures or injections with a 0- or 10-day global.

06Can excisional debridement be separately reported alongside 28445?

Only if documentation clearly supports debridement beyond simple wound care inherent to the approach. Per NCCI Chapter I, simple debridement of traumatized tissue is bundled. CPT 11010–11012 can be reported separately when the operative note specifically describes excisional debridement that exceeds standard approach prep.

07What ICD-10 diagnosis codes typically support 28445?

S92.1xx-series codes cover talus fractures. Specify laterality (A for initial encounter, S for sequela). The fracture type (neck, body, head, posterior process) should align with the documented anatomy — use the most specific subcategory available.

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 fracture mechanism, displacement pattern, named surgical approach, fixation hardware type and placement, and fluoroscopic confirmation from the surgeon's dictation. This prevents the single most common audit flag on 28445 — operative notes that omit the approach name or fail to distinguish the medial malleolar osteotomy as an access maneuver versus a separately reportable procedure.

See how Mira captures CPT 28445 documentation