Closed reduction of a fractured great toe phalanx or phalanges requiring manual realignment, without surgical incision.

Verified May 8, 2026 · 6 sources ↓

Medicare: $195.73
Work RVU: 1.64
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCKzanowFindacode

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Pre-reduction imaging confirming fracture displacement or angulation requiring manipulation
Explicit documentation that manual manipulation was performed — not just splinting or buddy-taping
Post-reduction imaging confirming alignment after manipulation
Specific phalanx identified (proximal, distal, or both) in the operative or procedure note
Type of immobilization applied (splint, cast, walking boot) and laterality
Anesthesia type used (local digital block, conscious sedation, or none)

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 52 Reduced services 58 Staged or related 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

28495 covers closed treatment of a great toe (hallux) phalanx fracture that requires hands-on manipulation to restore alignment. The great toe has two phalanges — proximal and distal — and either or both may be addressed under this code. The key distinction from 28490 is that manipulation is performed: the provider manually reduces the displaced fracture, confirms alignment with post-reduction imaging, and immobilizes the toe with a splint, cast, or walking boot. Local anesthesia at the toe is common; sedation is occasionally used.

The 90-day global period applies. That window covers the manipulation visit, the day before if applicable, and all routine follow-up visits, dressing changes, and imaging checks through day 90. Any unrelated E/M service during that window needs modifier 24. An E/M on the same day as the manipulation needs modifier 25 if a separately identifiable decision-making visit occurred before the procedure was initiated.

For Medicare patients, NCCI rules restrict reporting multiple closed fracture treatment codes when multiple fractures are stabilized with a single cast or splint — only one code is payable in that scenario under Part B. For non-Medicare payers following AMA CPT rules, each anatomically distinct fracture treated may be reported separately. Always verify payer-specific bundling rules before billing adjacent toe fractures on the same date.

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 (1.64) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (5.86) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.64
Practice expense RVU	4.02
Malpractice RVU	0.2
Total RVU	5.86
Medicare national rate	$195.73
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	$195.73
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI P3) Ambulatory surgical center (freestanding)	$134.94

Common denial reasons

The recurring reasons claims for CPT 28495 get rejected.

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

Upcoding to 28495 when documentation doesn't confirm manipulation was performed — payer downcodes to 28490
Missing post-reduction imaging note, leaving no evidence the manipulation was necessary or successful
Global period conflict — follow-up E/M billed without modifier 24 during the 90-day window
Medicare NCCI bundling denial when 28495 is billed alongside another closed toe fracture code stabilized with a single cast or splint
Unspecified ICD-10 fracture code (e.g., S92.401A) when laterality and displacement status are documentable and required by payer

Frequently asked questions

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

01What's the difference between 28490 and 28495?

28490 is closed treatment without manipulation — the fracture is stable and only requires immobilization. 28495 requires documented manual reduction of a displaced or angulated fracture. Billing 28495 without manipulation language in the note is the leading reason for downcodes.

02Can I bill 28495 and an E/M on the same day?

Yes, if a separately identifiable evaluation occurred before the decision to manipulate was made. Append modifier 25 to the E/M. Document the decision-making independently from the fracture care procedure note.

03Can I bill 28495 with another toe fracture code on the same date for Medicare?

No — under Medicare NCCI policy, when multiple toe fractures are stabilized with a single cast or splint, only one closed fracture treatment code is payable for Part B. For non-Medicare payers following AMA CPT rules, anatomically distinct fractures may each be reported separately.

04Does 28495 include the cost of the splint or cast?

Strapping and casting supplies are generally bundled into the global fracture care payment under Medicare. Payer policies on separately billing casting supplies (A4570, etc.) vary — confirm with each commercial contract.

05What ICD-10 codes pair with 28495?

Use a displaced fracture code from the S92.4x range (phalanx of great toe), with the correct laterality and encounter type (initial encounter = A for closed fracture). Unspecified or non-displaced codes may prompt medical necessity review because 28495 requires a manipulation.

06What happens if the patient needs repeat manipulation within the global period?

A planned staged procedure or return for the same problem uses modifier 78 (unplanned return to OR for related procedure). If manipulation is repeated in the office under the same global, document medical necessity clearly; payers may deny without a compelling clinical reason.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the fracture displacement description, confirmation that manual manipulation was performed, anesthesia type (digital block vs. other), post-reduction alignment assessment, immobilization device applied, and laterality — all from dictation. That prevents the most common denial for 28495: a note that documents splinting but omits any language showing hands-on reduction was performed, which triggers a downcode to 28490.

See how Mira captures CPT 28495 documentation