Open reduction of a tarsal bone fracture (excluding talus and calcaneus), with internal fixation applied when indicated, billed per bone treated.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $619.59
- Work RVU
- 8.58
- Global, days
- 90
- Region
- Foot & ankle
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 6 cited references ↓
- Identify each specific tarsal bone treated by name (navicular, cuboid, medial/intermediate/lateral cuneiform) — 'tarsal bone' alone is insufficient for multi-unit billing
- Confirm fracture displacement and the clinical indication for open (versus closed or percutaneous) treatment
- Describe the surgical approach, dissection planes, and reduction technique used for each bone
- Document whether internal fixation was applied and specify hardware type and placement (screw size, plate configuration)
- Record intraoperative fluoroscopy findings confirming reduction and fixation position
- Note explicit exclusion of talus and calcaneus if those bones are fractured and coded separately
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 6 cited references ↓
CPT 28465 covers open surgical treatment of a displaced tarsal bone fracture — navicular, cuboid, or any of the three cuneiforms — with internal fixation (screws, plates) used when needed. The talus and calcaneus are explicitly excluded; those bones have their own dedicated codes (28445 and 28415/28420, respectively). The descriptor says 'each,' meaning you can bill multiple units when you perform open reduction on more than one qualifying tarsal bone in the same operative session — but document each bone treated separately in the operative note.
The 90-day global period absorbs the preoperative visit on the day before surgery and all routine postoperative care through day 90. Separate billing for fracture-related follow-up in that window requires modifier 24 on E/M visits. A second surgical procedure during the global for a related complication — hardware failure, wound dehiscence — bills with modifier 78. An unrelated surgery in the same window uses modifier 79.
Not every tarsal fracture goes to 28465. If you treated percutaneously with manipulation, report 28456. Closed treatment without manipulation goes to 28450. Choosing the wrong treatment category is a leading audit flag for this family of codes.
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 (8.58) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (18.55) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 8.58 |
| Practice expense RVU | 8.61 |
| Malpractice RVU | 1.36 |
| Total RVU | 18.55 |
| Medicare national rate | $619.59 |
| 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 | $619.59 |
HOPD (APC 5114) Hospital outpatient department | $7,413.38 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $4,671.46 |
Common denial reasons
The recurring reasons claims for CPT 28465 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Multiple units billed without per-bone documentation in the operative note — payers deny the second unit when the note doesn't name each bone individually
- Upcoding from 28450 or 28456 when operative documentation describes a closed or percutaneous technique rather than open reduction
- Billing a related E/M visit during the 90-day global without modifier 24, triggering automatic denial
- Talus or calcaneus fracture coded to 28465 — those bones are excluded by the code descriptor and will deny on edit review
- Fluoroscopy or imaging guidance billed separately when it was used solely to confirm reduction during the 28465 procedure
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01Can I bill 28465 twice if I treated two tarsal bones in the same surgery?
02What's the difference between 28465, 28456, and 28450?
03Can I bill 28465 for a navicular fracture and 28445 for a talus fracture in the same session?
04Does the 90-day global include casting, boot management, and hardware checks?
05Should I bill fluoroscopy separately when I use it to confirm reduction during 28465?
06What modifier applies if the patient returns to the OR during the global period because a screw backs out?
07Is modifier 22 ever appropriate for 28465?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02aapc.comhttps://www.aapc.com/codes/cpt-codes/28465
- 03abos.orghttps://www.abos.org/wp-content/uploads/2019/12/sports-cpt-updated.pdf
- 04cms.govhttps://www.cms.gov/files/document/04-chapter4-ncci-medicare-policy-manual-2026-final.pdf
- 05vsac.nlm.nih.govhttps://vsac.nlm.nih.gov/context/cs/codesystem/CPT/version/2020/code/28465/info
- 06fastrvu.comhttps://fastrvu.com/cpt/28465
Mira Scribe
The Mira AI Scribe captures the specific tarsal bone name, fracture displacement status, surgical approach, reduction method, and whether internal fixation was placed and of what type — pulling this directly from dictation and populating the operative note fields that multi-unit and audit reviewers check first. That prevents the most common denial on 28465: a second billed unit with no per-bone documentation to support it.
See how Mira captures CPT 28465 documentation