Closed treatment of a tarsal bone fracture (excluding talus and calcaneus) with manipulation — reported once per bone treated.

Verified May 8, 2026 · 7 sources ↓

Medicare: $260.19
Work RVU: 3.16
Global, days: 90
Region: Foot & ankle

Drawn from CMSFastrvuAAPCAAOSCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Identify the specific tarsal bone(s) treated — navicular, cuboid, medial cuneiform, intermediate cuneiform, or lateral cuneiform — by name, not just 'midfoot fracture'.
Confirm that manipulation was performed and document the reduction technique, pre- and post-reduction alignment findings.
Document laterality (left, right, or bilateral) for each bone treated to support correct ICD-10 coding and modifier use.
If multiple tarsal bones are treated at the same session, document each bone separately with clinical rationale for manipulation vs. non-manipulation treatment for each.
For modifier 22 claims, document specific factors increasing complexity — comminution, repeated reduction attempts, neurovascular monitoring, or unusual anatomy.
Record post-reduction immobilization method (cast type, splint, boot) applied and any imaging used to confirm reduction.

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 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 28455 covers closed reduction with manipulation of a fractured tarsal bone, specifically the navicular, cuboid, medial cuneiform, intermediate cuneiform, or lateral cuneiform. The talus and calcaneus are explicitly excluded — those bones have their own code families (28435 series and 28400 series, respectively). The code is reported per bone, so bilateral or multi-bone injuries on the same foot require careful documentation of each fracture treated with manipulation.

The 90-day global period includes the manipulation, any casting or strapping applied at the same encounter, and all routine post-op follow-up through day 90. If the decision to treat was made at the same visit and that E/M is separately billable, append modifier 57. For a same-day E/M addressing a new or unrelated problem, append modifier 25 to the E/M. Fractures requiring substantially more work than typical — severe comminution, multiple reduction attempts, or complex alignment — may support modifier 22 with detailed documentation of the additional effort.

When multiple tarsal bones are fractured and each is treated with manipulation at the same encounter, 28455 can be reported for each bone with modifier 59 (or XS) to distinguish separate anatomic sites. If only one fracture required manipulation and another did not, report 28455 for the manipulated bone and 28450 for the non-manipulated bone. Accurate ICD-10 specificity — including laterality and bone-level detail — is essential to support multiple units.

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 (3.16) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (7.79) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	3.16
Practice expense RVU	4.37
Malpractice RVU	0.26
Total RVU	7.79
Medicare national rate	$260.19
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	$260.19
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI P3) Ambulatory surgical center (freestanding)	$146.69

Common denial reasons

The recurring reasons claims for CPT 28455 get rejected.

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

ICD-10 code specifies talus or calcaneus — those bones map to different CPT families; 28455 will deny with a talus or calcaneus diagnosis.
Multiple units of 28455 on the same date without modifier 59 or XS trigger NCCI bundling edits for the second and subsequent bones.
Missing or non-specific ICD-10 laterality causes claim mismatch and payer rejection.
28455 billed same-day as 28450 for the same bone — one fracture receives one treatment code; manipulation determines which code applies.
E/M billed same-day as 28455 without modifier 25, causing the E/M to deny as bundled into the global package.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Can 28455 be billed more than once on the same date?

Yes — 28455 is reported per bone. If two separate tarsal bones (e.g., the navicular and the cuboid) are each treated with manipulation at the same encounter, report 28455 twice with modifier 59 or XS on the second unit to distinguish separate anatomic sites. Document each bone and its reduction individually.

02What is the difference between 28450 and 28455?

28450 is for closed treatment of a tarsal bone fracture without manipulation. 28455 requires that manipulation — active reduction of the fracture — was performed. The clinical record must confirm a reduction attempt was made; simply applying a cast to an undisplaced fracture does not support 28455.

03Does 28455 cover the talus and calcaneus?

No. The talus maps to the 28435–28445 family and the calcaneus to the 28400–28420 family. Using 28455 with a talus or calcaneus ICD-10 code will cause a diagnosis-procedure mismatch denial.

04When does the 90-day global period start, and what does it include?

The global period begins the day of the procedure. It covers the day-of and day-before visit, the manipulation, any casting or strapping applied that day, and all routine follow-up through day 90. Unrelated E/M visits within that window need modifier 24; a new problem at a post-op visit needs modifier 24 as well.

05If the decision to treat surgically was made at the same E/M visit, which modifier applies?

Use modifier 57 on the E/M code. Modifier 57 applies when the decision for a 90-day global procedure is made at the E/M service on the day of or the day before the procedure. Do not use modifier 25 in this scenario — modifier 25 applies to minor (0- or 10-day global) procedures.

06Can 28455 and 28475 (metatarsal fracture with manipulation) be billed together?

Yes — they cover anatomically distinct bones (tarsal vs. metatarsal). Bill both with modifier 51 on the lower-valued code, and ensure ICD-10 codes are specific to each fracture site. NCCI does not bundle these as mutually exclusive, but documentation must support both reductions.

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 treated (by anatomic name), confirmation that manipulation was performed, reduction technique used, post-reduction alignment status, and immobilization applied. It also flags when multiple tarsal bones are treated at the same session, prompting separate per-bone documentation. This prevents the most common denial for 28455: a vague operative note that doesn't distinguish which bone was manipulated or confirm that reduction was actually attempted.

See how Mira captures CPT 28455 documentation