Closed treatment of a metatarsal fracture with manipulation, reported per bone treated

Verified May 8, 2026 · 5 sources ↓

Medicare: $275.89
Total RVUs: 8.26
Global, days: 90
Region: Foot & ankle

Drawn from CMS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Pre-manipulation radiographs documenting fracture displacement and confirming a metatarsal (specify which one: 1st–5th) was treated
Post-manipulation radiographs confirming reduction and final alignment — same encounter
Description of the manipulation technique performed, not just 'closed reduction attempted'
Anesthesia method used (local block, regional, sedation) and patient tolerance noted
Immobilization applied post-reduction: cast, splint, boot — type and material specified
Neurovascular status documented before and after manipulation
If multiple metatarsals treated, each bone must be individually identified in the operative/procedure note to support billing additional units

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

25 Significant separate E/M 50 Bilateral procedure 52 Reduced services 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 5 cited references ↓

CPT 28475 covers closed (non-surgical) treatment of a displaced metatarsal fracture that requires manual manipulation to achieve acceptable alignment. No incision is made — the fracture is reduced by hand, typically under local or regional anesthesia, and then immobilized with a cast, splint, or boot. The code is reported per bone, so if two metatarsals are manipulated in the same session, bill 28475 twice with modifier 59 on the additional unit to indicate distinct fracture sites.

28475 carries a 90-day global period. That covers the manipulation, all routine follow-up visits, and cast/dressing changes through day 90. Subsequent fracture care by a different provider during the global window requires modifier 54 (surgical care) or 55 (post-op management) with a transfer of care documented. An E/M visit on the same day as the manipulation — say, for an unrelated problem — needs modifier 25 appended to the E/M code.

Podiatry is the dominant billing specialty for this code. Orthopedic foot-and-ankle surgeons also use it. Payers scrutinize whether pre- and post-manipulation radiographs are documented to justify that manipulation was performed and achieved the intended correction. Missing imaging is the fastest path to a medical necessity denial.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	2.93
Practice expense RVU	4.94
Malpractice RVU	0.39
Total RVU	8.26
Medicare national rate	$275.89
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	$275.89
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 28475 get rejected.

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

Absence of post-reduction radiograph on the same date of service — payer treats manipulation as unsubstantiated
Billing 28475 when pre-procedure imaging shows a non-displaced fracture — that maps to 28470 (without manipulation), triggering a code-mismatch denial
Multiple units billed without modifier 59 distinguishing each separate metatarsal fracture site
Global period conflict: follow-up visit billed without modifier 24 when another provider's 90-day global is still open
Insufficient documentation of which specific metatarsal was treated — 'foot fracture' without laterality or bone identification

Frequently asked questions

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

01Can I bill 28475 twice if I manipulate two metatarsals in the same session?

Yes. 28475 is a per-bone code. Bill a second unit with modifier 59 (or XS) to identify it as a distinct fracture at a separate anatomic site. Each metatarsal must be individually documented in your procedure note.

02What's the difference between 28470 and 28475?

28470 is closed treatment without manipulation — used when the fracture is acceptably aligned and requires only immobilization. 28475 requires that you actually manipulate the fracture to achieve reduction. Billing 28475 on a non-displaced fracture is a common audit flag.

03Do I need to take post-reduction X-rays to support 28475?

Yes, and they need to be documented in the same encounter note. Post-manipulation radiographs confirm that reduction was attempted and achieved. Without them, payers routinely downcode to 28470 or deny on medical necessity grounds.

04How does the 90-day global period affect same-day E/M billing?

If you see the patient for an unrelated problem on the same day as the manipulation, append modifier 25 to the E/M code. For visits during the global period related to the fracture, no separate E/M is billable — those are included in the global.

05Is fluoroscopic guidance separately billable with 28475?

Closed fracture manipulation does not inherently include imaging guidance, so fluoroscopy can be separately reported if performed and documented. However, confirm payer policy — some commercial plans bundle intraoperative fluoroscopy into the global allowance for closed treatment codes.

06Can 28475 be billed bilaterally with modifier 50?

Technically modifier 50 applies when the identical procedure is performed on contralateral anatomic structures in the same session. Bilateral metatarsal fractures are uncommon, but if you manipulate the same-numbered metatarsal on both feet in one session, modifier 50 is appropriate with supporting documentation for each side.

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 (1st–5th), laterality, pre- and post-reduction alignment findings, manipulation technique, anesthesia method, and immobilization type from the provider's dictation. This prevents the two most common 28475 denials: missing post-reduction imaging documentation and failure to identify which bone was treated — both of which audit teams flag immediately.

See how Mira captures CPT 28475 documentation