Closed reduction with manipulation of a fractured phalanx or phalanges of any lesser toe (toes 2–5); reported per toe treated.

Verified May 8, 2026 · 6 sources ↓

Medicare: $174.35
Work RVU: 1.52
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCNIH

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 toe(s) were treated and identify the exact phalanx involved (proximal, middle, or distal).
Confirm the fracture was closed and that manipulation (reduction) was performed — without manipulation, use 28510 instead.
Document pre- and post-reduction radiographic findings to support medical necessity and confirm alignment.
Record the type of immobilization applied (buddy taping, splint, cast) — this is bundled and not separately billable but must be noted.
If multiple toes are treated, document each fracture and its reduction separately to justify multiple units with distinct T-modifiers.
Note any neurovascular status assessment of the affected digit pre- and post-manipulation.

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 51 Multiple procedures 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 XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

28515 covers closed treatment of a phalanx fracture in any toe except the great toe when manipulation is required to reduce the fracture. The code is reported per toe, so if you treat two separate lesser-toe fractures with manipulation during the same session, you report 28515 twice — each unit differentiated by a toe-specific modifier (T1–T9). The companion code for manipulation of a great toe phalanx fracture is 28495 (without manipulation: 28490); for lesser toes without manipulation, use 28510.

The 90-day global period bundles the initial casting, splinting, or strapping — do not separately bill application codes for immobilization applied at the time of fracture treatment. All routine follow-up visits through day 90 are also included. If a new problem arises requiring a separate E/M during the global, append modifier 24. A staged or related subsequent procedure in the global window takes modifier 58; an unrelated procedure takes modifier 79.

When two toe fractures are treated at the same session — e.g., a lesser toe (28515) and the great toe (28490) — report the higher-RVU code first and append modifier 59 or XS to the second code to establish distinct procedural services. Digit-specific T-modifiers (TA–T9) already convey laterality and digit identity; adding LT or RT on top of a T-modifier is redundant. Per NCCI policy, local anesthetic injected to facilitate the manipulation is not separately billable.

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 (1.52) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (5.22) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.52
Practice expense RVU	3.52
Malpractice RVU	0.18
Total RVU	5.22
Medicare national rate	$174.35
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	$174.35
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI P3) Ambulatory surgical center (freestanding)	$118.16

Common denial reasons

The recurring reasons claims for CPT 28515 get rejected.

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

Missing or incorrect digit modifier — payers reject duplicate 28515 units when T1–T9 modifiers are absent or reused for the same digit.
Separate billing of casting or strapping (e.g., 29240, 29550) applied at the same encounter; NCCI bundles immobilization into the fracture treatment code.
Great-toe fracture coded as 28515 — the great toe requires 28495 (with manipulation) or 28490 (without); 28515 is limited to lesser toes.
Unbundling local anesthetic injection (64450) billed by the treating surgeon alongside the manipulation; NCCI does not allow separate reporting.
ICD-10 diagnosis code does not specify a lesser toe phalanx fracture, creating a CPT-to-diagnosis mismatch that triggers medical necessity denial.

Frequently asked questions

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

01What is the difference between 28515 and 28510?

28510 is closed treatment of a lesser toe phalanx fracture without manipulation. Use 28515 only when you actively reduce the fracture. If the operative note doesn't explicitly describe manipulation, auditors will downcode to 28510.

02Can 28515 be billed more than once on the same date of service?

Yes — the descriptor says 'each,' and you report one unit per toe treated with manipulation. Each unit must carry a distinct T-modifier (T1–T9) identifying the specific digit. Without digit-specific modifiers, duplicate units will deny.

03Which modifier indicates the specific toe when billing 28515?

Use T1–T9 for lesser toes (T1 = left foot, second digit through T5 = left foot, fifth digit; T6–T9 for the right foot). These modifiers carry the laterality information, so adding LT or RT on top is redundant and can cause claim edits.

04If I treat a lesser toe fracture and a great toe fracture on the same visit, how do I bill?

Report 28515 (with appropriate T-modifier) first if its RVU is higher, then 28490 or 28495 for the great toe with modifier TA. Append modifier 59 or XS to the second code to identify distinct procedural services. Check payer preference between 59 and XS.

05Can I separately bill the splint or buddy-tape application at the same encounter?

No. NCCI bundles initial casting, splinting, and strapping into all fracture treatment codes. Billing a separate strapping or cast application code (e.g., 29550) on the same date will be denied as an NCCI edit violation.

06Does the 90-day global period for 28515 include all follow-up visits?

Yes. Routine post-reduction visits, dressing changes, and repeat imaging to confirm healing within 90 days are included in the global. Bill modifier 24 on an E/M only if you're treating a problem unrelated to the toe fracture during that window.

07Can the surgeon separately bill a nerve block (64450) used for local anesthesia during manipulation?

No. Per NCCI policy, local or regional anesthetic administered by the performing surgeon to facilitate a surgical or manipulative procedure is not separately reportable.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the specific toe treated (e.g., left foot, third digit), confirms the fracture was closed, documents that manual manipulation was performed to achieve reduction, records the post-reduction position, and notes the immobilization method applied. This prevents the two most common denials for 28515: missing digit-level specificity that blocks use of T-modifiers, and absence of manipulation documentation that auditors use to downcode to 28510.

See how Mira captures CPT 28515 documentation