Closed treatment of a tarsal bone fracture (excluding talus and calcaneus) without manipulation — billed per bone treated.

Verified May 8, 2026 · 5 sources ↓

Medicare: $231.47
Work RVU: 1.98
Global, days: 90
Region: Foot & ankle

Drawn from CMSEmednyPodiatrymAAPC

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Identify the specific tarsal bone(s) fractured — navicular, cuboid, medial/middle/lateral cuneiform — by name, not just 'midfoot fracture'
Confirm no manipulation was performed; if any reduction attempt was made, 28455 applies instead
Document laterality (left or right foot) in both the note and on the claim
Record treatment rendered: casting, splinting, strapping, or protected weight-bearing instructions
If billing multiple units for multiple tarsal bones, document each fracture site separately with distinct ICD-10-CM codes
For modifier 22, quantify additional work with objective findings — comminution, osteoporosis, or significant soft-tissue involvement

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 57 Decision for surgery 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 5 cited references ↓

CPT 28450 covers non-manipulative closed treatment of a single tarsal bone fracture, excluding the talus and calcaneus (which have their own codes). Applicable bones include the navicular, cuboid, and the three cuneiforms. The descriptor is per bone, so if two cuneiform fractures are treated without manipulation at the same encounter, 28450 is reported twice — with modifier 59 on the second unit to distinguish the separate injury sites.

The 90-day global period applies. That window covers the surgery date, the day-before visit, and all routine fracture follow-up through day 90. Casting, splinting, and dressing changes in that window are bundled. An E/M for an unrelated problem during the global requires modifier 24. A same-day E/M where the fracture diagnosis is established for the first time and a separate significant service is rendered requires modifier 25.

Site of service matters. HOPD and ASC payment rates differ — see the Site of Service comparison table. Most billing is in an outpatient facility or office setting; confirm your payer's place-of-service requirements for fracture care before submitting.

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 (1.98) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (6.93) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.98
Practice expense RVU	4.67
Malpractice RVU	0.28
Total RVU	6.93
Medicare national rate	$231.47
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	$231.47
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 28450 get rejected.

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

Incorrect code selection — talus fractures (28430) and calcaneus fractures (28400) are excluded from 28450 and denied when miscoded
Missing laterality modifier — many payers require LT or RT on unilateral foot procedures
Multiple units billed without modifier 59 on the additional unit, triggering NCCI bundling edits
Global period conflict — E/M billed without modifier 24 during the 90-day post-op window
ICD-10-CM mismatch — diagnosis code does not specify a tarsal bone fracture or defaults to an excluded site (S92.0x for calcaneus, S92.1x for talus)

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Can 28450 be billed more than once when multiple tarsal bones are fractured in the same foot?

Yes. The descriptor is 'each,' so each separately treated tarsal bone fracture supports one unit. Append modifier 59 to the second and subsequent units to identify distinct fracture sites, and assign a separate ICD-10-CM code for each bone.

02What is the global period for 28450, and what does it include?

28450 carries a 90-day global period. It covers the day before surgery, the procedure day, and all routine fracture follow-up visits, casting changes, and dressing changes through day 90. Unrelated E/M services in that window need modifier 24.

03Does applying a cast or splint affect whether 28450 is billable?

Application of a cast or splint is not strictly required to bill 28450, but the record must document active treatment — protected weight-bearing instructions, immobilization device, or similar — not just a diagnosis. Billing fracture care codes on diagnosis alone invites payer scrutiny.

04How does 28450 differ from 28455?

28450 is closed treatment without manipulation. 28455 applies when the provider performs any manipulation or reduction attempt to realign the fracture. If manipulation is attempted — even unsuccessfully — 28455 is the correct code.

05Which modifier applies if a colleague assumes fracture care that another physician initiated?

Use split-care modifiers: the treating physician bills 28450 with modifier 54 (surgical care only) if they perform the procedure but not post-op follow-up, and modifier 55 for the physician providing only post-op management. Confirm the payer accepts split global billing before submitting.

06Is 28450 appropriate for a navicular, cuboid, or cuneiform fracture?

Yes — all three cuneiforms, the navicular, and the cuboid are covered by 28450. The talus and calcaneus are explicitly excluded and have separate code families (28430 and 28400 respectively).

Sources & references

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

Mira Scribe

Mira's AI scribe captures the specific tarsal bone name, laterality, fracture pattern (nondisplaced vs. comminuted), treatment method (short leg cast, walking boot, strapping), and whether any attempted reduction occurred. That prevents the most common audit flag: operative and clinic notes that document 'midfoot fracture treated' without naming the bone — which leaves the coder unable to confirm 28450 vs. 28455 and unable to rule out a calcaneus or talus site excluded from this code.

See how Mira captures CPT 28450 documentation