Percutaneous skeletal fixation of a closed fracture of the great toe phalanx or phalanges, performed with manipulation to restore alignment.

Verified May 8, 2026 · 6 sources ↓

Medicare: $548.44
Work RVU: 2.42
Global, days: 90
Region: Foot & ankle

Drawn from CMSCgsmedicareBedrockbillingEmednyPayerprice

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm fracture is closed — open fractures require a different code family
Document that manipulation was performed to achieve or confirm alignment
Specify percutaneous pin fixation was performed, including pin count and technique
Record laterality explicitly (left vs. right great toe) to support TA or T5 modifier
Pre- and post-reduction imaging (fluoroscopy or X-ray) confirming fracture position
Operative note must name the phalanx or phalanges involved (proximal, distal, or both)

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 52 Reduced services 59 Distinct service 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 28496 covers closed fracture treatment of the great toe (phalanx or phalanges) when the surgeon both manipulates the fracture and stabilizes it with percutaneous pin fixation. This is a step up from 28495 (manipulation without pinning) and below 28505 (open treatment with internal fixation). The distinction matters at audit: if your operative note documents pinning, use 28496; if no hardware was placed, 28495 is the correct code.

The 90-day global period applies. All routine post-op visits, pin removal, and dressing changes within that window are bundled. Bill modifier 24 for unrelated E/M visits during the global, or modifier 78 if the patient returns to the OR for a complication related to the original pinning. An unrelated procedure in the global period needs modifier 79.

Side laterality is required for clean claims. Use TA for the left great toe and T5 for the right great toe. Bilateral great toe fixation is rare but would be reported with modifier 50 on a single claim line. NCCI bundles several component codes into 28496 — confirm your NCCI PTP pairs before billing ancillary codes 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 (2.42) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (16.42) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	2.42
Practice expense RVU	13.5
Malpractice RVU	0.5
Total RVU	16.42
Medicare national rate	$548.44
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	$548.44
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 28496 get rejected.

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

Missing laterality modifier (TA or T5) — many payers auto-deny without it
Billing 28496 alongside 28495 for the same toe on the same date — these are mutually exclusive
Post-op E/M visits billed without modifier 24, triggering global period bundling denial
Upcoding to 28496 when operative note documents manipulation only, without percutaneous pinning
NCCI bundling denial when component codes are billed separately without an appropriate modifier

Frequently asked questions

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

01What's the difference between 28495 and 28496?

28495 is closed manipulation of a great toe fracture without any hardware. 28496 requires both manipulation and percutaneous pin fixation. If your note doesn't document pinning, you can't bill 28496 — audit reviewers will downcode it to 28495.

02Which laterality modifiers apply to 28496?

Use TA for the left great toe and T5 for the right great toe. Per CMS NCCI policy, toe procedures should carry these digit-specific modifiers, and many payers deny without them. Modifier LT/RT alone is not sufficient for toe-level specificity.

03Can I bill a separate E/M on the same day as 28496?

Only if it's a significant, separately identifiable service unrelated to the decision to perform the pinning. Append modifier 25 to the E/M. The decision to perform a minor surgical procedure is already bundled into the procedure payment.

04How long is the global period for 28496?

90 days. That covers the surgery day, the day-before pre-op visit if applicable, and all routine follow-up including pin removal through day 90. Anything unrelated in that window needs modifier 24 (E/M) or 79 (unrelated procedure).

05When would I use modifier 78 after billing 28496?

Modifier 78 applies if the patient has an unplanned return to the OR for a complication directly related to the original pinning — for example, pin migration requiring revision. Use modifier 79 if the return is for an entirely unrelated procedure during the same global period.

06Can 28496 be billed bilaterally?

Yes, but bilateral great toe fracture fixation is uncommon. If performed, report one claim line with modifier 50. Per CMS MCPM Chapter 12, bilateral procedures go on a single line with modifier 50 unless the code descriptor already defines the service as bilateral.

07What ICD-10 codes map to 28496?

Fractures of the great toe phalanges fall under S92.4x (fracture of great toe) subcategories. Use the appropriate seventh character for encounter type: A for initial, D for subsequent, S for sequela. Initial surgical encounter uses the 'A' character.

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 laterality, the specific phalanx involved, confirmation that closed manipulation was performed, and that percutaneous pin fixation was placed — along with fluoroscopic confirmation of alignment. That documentation set prevents the two most common denials: missing laterality and operative notes that describe manipulation without pinning, which would drop the code to 28495.

See how Mira captures CPT 28496 documentation