Closed treatment of a tarsal bone dislocation (excluding talotarsal joints), performed without anesthesia.

Verified May 8, 2026 · 4 sources ↓

Medicare: $199.07
Work RVU: 2.14
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCAAOS

Documentation requirements

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

Source · Editorial brief grounded in 4 cited references ↓

Identify the specific tarsal bone(s) dislocated — navicular, cuboid, medial/intermediate/lateral cuneiform, or calcaneus; document that talotarsal joints are not involved.
State explicitly that the procedure was performed without anesthesia to support the 28540 level of service versus a higher-level code.
Document the reduction technique and confirm the joint was restored to acceptable alignment, including post-reduction assessment (clinical or imaging).
Record all immobilization applied (cast, splint, strapping) — type, material, and extent — to confirm no separate casting code is warranted.
Include mechanism of injury and relevant physical exam findings to support medical necessity and ICD-10 code specificity.
Note laterality (left vs. right foot) to support LT/RT modifier use and ICD-10 laterality requirements.

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 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

What this code covers

Source · Editorial summary grounded in 4 cited references ↓

CPT 28540 covers closed reduction of a tarsal bone dislocation — midfoot or rearfoot bones (navicular, cuboid, cuneiforms, or calcaneus) — where no anesthesia is administered and no surgical incision is made. The talotarsal joints are explicitly excluded from this code; dislocations involving the talus articulating with another tarsal bone require separate coding.

The 90-day global period includes the initial casting, splinting, or strapping applied at the time of reduction. Per NCCI policy, you cannot bill a separate casting or strapping code alongside 28540 — it's bundled. If a single cast or splint stabilizes multiple closed dislocations or fractures without manipulation in the same anatomic region, report only one code for that region.

For same-day E/M services, modifier 25 is required to separate a significant, separately identifiable evaluation from the procedure itself. If the decision for surgery was made during a visit on the day of or day before a related major procedure in the global period, modifier 57 applies to the E/M — but 28540 itself carries a 90-day global, so be precise about timing.

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 (2.14) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (5.96) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	2.14
Practice expense RVU	3.64
Malpractice RVU	0.18
Total RVU	5.96
Medicare national rate	$199.07
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	$199.07
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI P3) Ambulatory surgical center (freestanding)	$122.19

Common denial reasons

The recurring reasons claims for CPT 28540 get rejected.

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

Separate casting or strapping code (e.g., 29581) billed alongside 28540 — bundled per NCCI; cast application is included in the global package.
Talotarsal joint dislocation coded as 28540 — this joint combination is excluded from the code and requires a different CPT.
Missing laterality modifier when payer requires LT or RT for unilateral foot procedures.
E/M billed same-day without modifier 25, triggering denial of the office visit as incidental to the procedure.
ICD-10 code mismatch — using a fracture diagnosis code rather than a dislocation-specific code (S93.x range) for a pure dislocation.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 4 cited references ↓

01Can I bill a casting code with 28540?

No. NCCI explicitly bundles casting, splinting, and strapping into closed dislocation treatment codes. Billing a separate casting code alongside 28540 will be denied.

02Does 28540 cover talotarsal dislocations?

No. Talotarsal joint dislocations — where the talus articulates with another tarsal bone — are excluded from 28540. Use the appropriate code for that specific dislocation.

03What modifier do I use if I treat the same dislocation again within the 90-day global?

Modifier 78 if the return procedure is related to the original treatment (e.g., re-dislocation requiring repeat reduction). Modifier 79 if the procedure is unrelated to the original dislocation.

04Can I bill an E/M on the same day as 28540?

Yes, but only with modifier 25 on the E/M. The visit must be significant and separately identifiable from the pre-service evaluation included in the procedure's global package.

05If the patient has multiple tarsal bone dislocations stabilized with a single splint, how many units of 28540 can I bill?

One. Per NCCI policy, multiple dislocations treated without manipulation and stabilized with a single cast or splint in the same anatomic area are reported with a single CPT code.

06Is modifier 50 appropriate for bilateral tarsal bone dislocations?

Yes, if both feet require closed reduction at the same encounter. Alternatively, bill 28540-LT and 28540-RT on separate lines depending on payer preference — confirm with the specific payer before submitting.

07When is modifier 22 appropriate for 28540?

When the reduction required substantially more effort than typical — for example, a chronic or complex dislocation with severe swelling or deformity requiring significantly extended manipulation. Documentation must detail the specific circumstances that increased work.

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 tarsal bone dislocated, confirmation that talotarsal joints were not involved, the absence of anesthesia, the reduction technique used, post-reduction alignment assessment, and the type of immobilization applied. This prevents the two most common audit flags for 28540: upcoding due to missing anesthesia documentation and separate casting charges that NCCI bundles into the global.

See how Mira captures CPT 28540 documentation