Closed treatment of a single metatarsal fracture performed without any manipulation of the fracture fragments.

Verified May 8, 2026 · 8 sources ↓

Medicare: $237.15
Total RVUs: 7.1
Global, days: 90
Region: Foot & ankle

Drawn from CMSTldsystemsPodiatrymAssociationdatabaseAAPC

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Confirm closed treatment with no manipulation performed — note absence of reduction attempt
Specify which metatarsal(s) are fractured with bone-level detail, not 'unspecified metatarsal'
Document the type of immobilization applied (cast, splint, cam walker, strapping, or none)
Record imaging findings (pre- and post-treatment X-rays) confirming fracture alignment and non-displaced status
Note mechanism of injury and clinical findings supporting the fracture diagnosis
If billing in a post-op period of a prior procedure, document that the current fracture is a new or unrelated injury

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 59 Distinct service 76 Repeat, same physician 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

CPT 28470 covers closed, non-manipulative treatment of a metatarsal fracture — meaning the provider manages the injury without making an incision and without physically reducing or repositioning the bone. Treatment typically involves protective immobilization such as a cast, splint, cam walker, or strapping. The 90-day global period includes all routine follow-up, dressings, and cast checks through day 90. Anything unrelated to the fracture billed during that window needs modifier 24 or 25.

The 'each' descriptor in the code language creates a persistent billing trap. CMS NCCI policy overrides that language for Medicare: if a single cast, splint, or strapping treats multiple metatarsal fractures in the same foot, only one unit of 28470 is billable. If no immobilization device is used, the same one-unit rule applies. Non-Medicare payers may follow CPT's 'each' language more liberally, but verify before billing multiples. The MUE of 2 per date of service is further constrained by NCCI policy for same-foot fractures under the same treatment.

For fractures involving adjacent metatarsals, each fracture site should be supported with its own specific ICD-10 diagnosis code (e.g., S92.311A for the 1st, S92.321A for the 2nd). Unspecified metatarsal codes invite audits and underpayment. If manipulation was attempted — even if unsuccessful — or if percutaneous fixation was used, 28470 is the wrong code: look to 28475 (with manipulation) or 28476 (percutaneous fixation).

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	1.98
Practice expense RVU	4.83
Malpractice RVU	0.29
Total RVU	7.1
Medicare national rate	$237.15
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	$237.15
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 28470 get rejected.

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

Too many units billed — Medicare limits to one unit when a single cast or splint covers multiple metatarsal fractures in the same foot
Documentation only shows cam walker dispensing without clinical assessment or fracture treatment narrative, leaving payer unable to confirm 28470 was actually performed
Unspecified metatarsal ICD-10 code (S92.302A) used instead of bone-specific diagnosis, causing CPT-ICD mismatch denial
28470 billed during active global period of a prior procedure without modifier 79, triggering automatic denial
Incorrect code selected when manipulation was attempted — 28470 does not cover even failed reduction attempts

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01Can I bill 28470 multiple times for fractures of the 2nd, 3rd, and 4th metatarsals treated with a single cast?

No — not for Medicare. NCCI policy limits billing to one unit of 28470 when a single cast, splint, or strapping treats multiple metatarsal fractures in the same foot. Non-Medicare payers may follow CPT's 'each' language and allow multiple units; verify with the specific payer before billing multiples.

02What modifier is needed when billing 28470 during an active global period from a prior procedure?

Use modifier 79 if the metatarsal fracture is unrelated to the prior surgery and you are within that surgery's global period. Modifier 79 signals an unrelated procedure in the post-op period. Do not use modifier 78, which is reserved for unplanned returns for a related complication.

03The patient tried to walk off a suspected fracture and I attempted a reduction that didn't move the bone — does 28470 still apply?

No. If manipulation was attempted — even unsuccessfully — the correct code is 28475 (closed treatment with manipulation). The attempt itself changes the code selection regardless of the outcome.

04Can I separately bill for the X-rays taken to confirm the fracture at the same visit?

Yes. Diagnostic radiology (73620–73630) is separately reportable with 28470. X-rays taken to assess fracture healing during the global period are also separately billable.

05Does applying a cam walker alone support billing 28470?

Not reliably. Payers — including UHC on appeal — have denied 28470 when documentation only records cam walker dispensing without a clinical narrative confirming fracture assessment and treatment. The note must document the fracture, the treatment plan, and the provider's clinical decision-making, not just the device.

06What codes should I consider instead of 28470 if the fracture required fixation?

Use 28476 for percutaneous skeletal fixation of a metatarsal fracture, or 28485 for open treatment. 28470 is strictly for closed treatment without any manipulation or fixation.

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 metatarsal treated, confirms no manipulation was performed, records the immobilization type applied, and extracts bone-specific diagnosis codes from the dictation. This prevents the two most common 28470 denials: unspecified metatarsal ICD-10 coding and chart notes that document only device dispensing without a treatment narrative.

See how Mira captures CPT 28470 documentation