Percutaneous skeletal fixation of a tarsal bone fracture (excluding the talus and calcaneus), performed with manipulation, reported per bone treated.

Verified May 8, 2026 · 6 sources ↓

Medicare: $383.44
Work RVU: 2.79
Global, days: 90
Region: Foot & ankle

Drawn from CMSAbosCgsmedicareFastrvuAAPC

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify the specific tarsal bone(s) treated — navicular, cuboid, medial cuneiform, intermediate cuneiform, or lateral cuneiform; generic 'tarsal fracture' is insufficient.
Confirm fracture manipulation was performed and document the pre- and post-manipulation alignment or fluoroscopic findings.
Specify the percutaneous fixation technique and hardware used (e.g., K-wire, cannulated screw), including number and trajectory.
Document imaging guidance used intraoperatively (fluoroscopy); note if performed by the surgeon vs. separate technician, as this affects whether imaging should be separately coded.
If billing 28456 more than once (multiple tarsal bones), document each bone and fixation as a distinct procedure with anatomic specificity to support modifier 59.
Record the clinical indication, fracture classification or description, and why percutaneous rather than open treatment was chosen.

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 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 73 Discontinued pre-anesthesia 74 Discontinued post-anesthesia 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 28456 covers percutaneous skeletal fixation of a fractured tarsal bone — specifically any of the midfoot tarsals (navicular, cuboid, or one of the three cuneiforms) — combined with fracture manipulation. Hardware such as Kirschner wires or screws is placed through the skin rather than through an open incision. The code is reported per bone, so if two separate tarsal bones are fixed in the same session, you can report 28456 twice with modifier 59 to distinguish the distinct fixation sites. Talus and calcaneus fractures have their own dedicated codes (28436 and 28406 respectively) and do not fall under this code.

The 90-day global period means the surgical fee bundles the day-before visit, the procedure itself, and all routine post-op management through day 90. Separate E/M visits in that window require modifier 24 (unrelated) or 25 is not applicable post-op — use 24 for established unrelated management. A return to the OR for a related complication during the global period requires modifier 78; an unrelated surgery in the same global window requires modifier 79.

This code appears in both HOPD and ASC settings. Check NCCI PTP edits before billing 28456 alongside other foot fixation codes on the same date — bundling flags are common when multiple foot fracture codes are submitted without appropriate modifier documentation justifying distinct anatomic sites.

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 (2.79) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (11.48) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	2.79
Practice expense RVU	8.1
Malpractice RVU	0.59
Total RVU	11.48
Medicare national rate	$383.44
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	$383.44
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,784.78

Common denial reasons

The recurring reasons claims for CPT 28456 get rejected.

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

Operative note identifies the fracture as a talus or calcaneus — those bones have their own codes (28436, 28406) and 28456 is incorrect.
Duplicate billing without modifier 59 when two tarsal bones are fixed in the same session — payer bundles both units without a distinct anatomic modifier.
Missing documentation of manipulation; payers deny 28456 and downcode to the non-manipulation percutaneous fixation level when no pre/post reduction is documented.
NCCI bundling conflict when 28456 is billed same-day with overlapping foot fracture or dislocation codes without a valid modifier and supporting documentation.
Global period violation — post-op E/M visits billed without modifier 24 during the 90-day window are denied as bundled.

Frequently asked questions

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

01Can I bill 28456 for a navicular fracture and a cuboid fracture fixed in the same session?

Yes. The code is reported per bone. Bill 28456 twice and append modifier 59 (or XS for distinct anatomic site) to the second unit. Your operative note must document each bone, its fixation hardware, and the manipulation performed at each site.

02What is the difference between 28456 and 28465?

28456 is percutaneous fixation with manipulation. 28465 is open treatment of the same tarsal bones. If you make an incision to directly visualize and fix the fracture, 28465 applies. Percutaneous means hardware is placed through the skin under fluoroscopic guidance without open exposure.

03Does the global period on 28456 cover post-op casting and cast changes?

Yes. The 90-day global bundles routine post-op services including cast application at the time of surgery, routine cast checks, and removal. Separately billing cast-related codes during the global for the same condition will be denied. If a new cast is needed due to a distinct, unrelated problem, modifier 24 applies.

04Is fluoroscopy separately billable with 28456?

Generally no for Medicare. Fluoroscopic guidance used intraoperatively for percutaneous pin or screw placement is considered integral to the fixation and is not separately reimbursed. Check individual payer policies — some commercial plans differ.

05When does modifier 22 apply to 28456?

Use modifier 22 when the procedure required substantially greater work than typical — for example, severely comminuted fracture with difficult reduction, morbid obesity complicating access, or unusual hardware demands. Attach a cover letter quantifying the additional time and effort; payers routinely request records before paying the upcharge.

06Does 28456 cover midfoot Lisfranc-pattern tarsal injuries?

Not by itself. True Lisfranc injuries involve the tarsometatarsal joints and may require separate dislocation codes or open treatment codes. If the injury pattern involves both tarsal bone fractures and tarsometatarsal joint disruption, review NCCI edits carefully and document each anatomic component treated to support separate code reporting.

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 specific tarsal bone name, confirmation that manipulation was performed with pre- and post-reduction alignment, the percutaneous fixation hardware type and placement detail, and intraoperative fluoroscopy use — directly from surgeon dictation. This prevents the most common 28456 denial: a note that says 'tarsal fracture fixation' without naming the bone or documenting reduction, which auditors flag for downcoding or rejection.

See how Mira captures CPT 28456 documentation