Percutaneous skeletal fixation of a metatarsal fracture requiring manipulation, performed on a single metatarsal bone.

Verified May 8, 2026 · 6 sources ↓

Medicare: $387.78
Work RVU: 3.51
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCAAOSPayerprice

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify which metatarsal(s) were treated by number (1st through 5th) and laterality (left/right).
Confirm the fracture was closed; open fractures route to 28485.
Document that manipulation was performed — absence of this in the operative note downgrades to 28475 or 28470.
Describe the percutaneous fixation technique: pin type, number of pins/screws, and fluoroscopic guidance used.
Include pre- and post-reduction imaging results confirming alignment.
Record the mechanism of injury and clinical findings supporting fracture diagnosis with corresponding ICD-10 code (S92.2xx series for metatarsal fractures).

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 50 Bilateral procedure 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 6 cited references ↓

CPT 28476 describes closed treatment of a metatarsal fracture with manipulation and percutaneous skeletal fixation — meaning pins or screws are placed through the skin to stabilize the fractured metatarsal without open incision. Manipulation is inherent to the code; if no manipulation is performed, 28470 (without manipulation, no fixation) or 28475 (with manipulation, no fixation) would be the appropriate alternatives. The 'each' descriptor means you report 28476 once per metatarsal treated; multiple fractured metatarsals fixated in the same session require separate line entries with modifier 59 or XS to distinguish distinct bones.

The 90-day global period covers the day before surgery, the operative day, and all routine post-op care through day 90. Separate E/M visits in that window require modifier 24 (unrelated) or 25 (significant and separately identifiable, same-day pre-op). If the decision for surgery was made at an E/M visit on the day of or day before the procedure, append modifier 57 to that E/M — required for any 90-day global procedure.

Site of service matters here: the HOPD payment exceeds ASC payment by roughly double (see the Site of Service comparison table). Most commercial payers align to Medicare logic on metatarsal fixation, but verify bilateral coding rules — modifier 50 applies if both feet are treated, with LT/RT used when only one side is treated in a bilateral scenario.

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 (3.51) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (11.61) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	3.51
Practice expense RVU	7.55
Malpractice RVU	0.55
Total RVU	11.61
Medicare national rate	$387.78
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	$387.78
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 28476 get rejected.

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

Unbundling without modifier 59/XS when multiple metatarsals are billed on the same date — payers collapse to a single unit without proper distinction.
Missing manipulation documentation causes downcoding to 28470 (no manipulation, no fixation).
Laterality modifier absent (LT or RT) — many Medicare MACs and commercial payers require it for foot procedures.
Billing an E/M in the 90-day global period without modifier 24 or 25, triggering automatic denial.
ICD-10 code mismatch — using an open fracture code (S92.2xx with 7th character for open) against a closed-treatment procedure code.

Frequently asked questions

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

01Can I bill 28476 for each metatarsal treated in the same session?

Yes. The code descriptor includes 'each,' so report one unit per metatarsal fixed. Add modifier 59 or XS on the additional lines to signal distinct bones and prevent automatic bundling denials.

02What's the difference between 28475 and 28476?

28475 is closed treatment with manipulation only — no hardware placed. 28476 adds percutaneous skeletal fixation (pins or screws through the skin). If you placed hardware, 28476 is correct; if you manipulated and casted without fixation hardware, use 28475.

03When does a metatarsal fracture route to 28485 instead of 28476?

28485 is for open treatment — either an open fracture requiring surgical exposure, or a closed fracture where the surgeon opens the fracture site. If the fixation was percutaneous without incising down to bone, 28476 is correct.

04Does fluoroscopic guidance bill separately with 28476?

Intraoperative fluoroscopy for fracture reduction guidance is generally considered bundled into the fracture care code. Verify payer policy before billing 77002 separately — most payers deny it as inclusive.

05How do I handle a return to the OR during the 90-day global for hardware removal or revision?

If the return is for a complication directly related to the original fixation, use modifier 78 (unplanned return, related procedure). If the return is for an unrelated foot problem during the global, use modifier 79. Do not use 78 for planned staged procedures — that's modifier 58.

06Is modifier 50 appropriate if I fix metatarsal fractures on both feet in the same session?

Yes. Bilateral metatarsal fixation in one session supports modifier 50. Some payers prefer separate line items with LT and RT rather than a single line with 50 — confirm the specific payer's bilateral billing policy before submitting.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures metatarsal number and laterality from dictation, confirms manipulation language is present, and flags the fixation technique (pin count, percutaneous approach, fluoroscopy use) — the exact elements auditors check when distinguishing 28476 from 28475 or 28485. Missing any of these triggers downcoding or open-procedure scrutiny before the claim leaves the practice.

See how Mira captures CPT 28476 documentation