Closed treatment of a tarsal bone dislocation (other than talotarsal) requiring anesthesia, with or without manipulation.

Verified May 8, 2026 · 5 sources ↓

Medicare: $637.62
Work RVU: 3.32
Global, days: 90
Region: Foot & ankle

Drawn from CMSHealthEmednyMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Identify the specific tarsal bone(s) dislocated — navicular, cuboid, or cuneiform — not just 'foot dislocation'
Document why anesthesia was required (e.g., patient unable to tolerate manipulation, muscle spasm, neurovascular compromise)
Record the reduction technique, pre- and post-reduction neurovascular status, and confirmation of reduction
Specify laterality (left or right foot) in both the operative note and diagnosis coding
Document post-reduction immobilization method, weight-bearing status, and follow-up plan within the 90-day global

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 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 LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 28546 covers closed reduction of a non-talotarsal tarsal bone dislocation performed under anesthesia. The tarsal bones in scope include the navicular, cuboid, and cuneiforms — joints such as Lisfranc-adjacent midfoot articulations where manipulation under anesthesia is necessary to achieve reduction. This code sits one step above 28545, which covers the same dislocation without anesthesia requirement.

The 90-day global period applies. All routine follow-up visits, cast checks, and dressing changes through day 90 are bundled. Bill separate E/M services within the global only with modifier 24 (unrelated) or 25 (significant separate service same-day). If the closed reduction fails and open treatment is performed during the same encounter or a later session, the open procedure code (28555) replaces — not supplements — 28546.

Side-specific modifiers LT and RT are expected. Bilateral tarsal dislocations are rare but would require modifier 50. If fluoroscopic guidance is used to confirm reduction, check payer policy — some bundle imaging into the reduction code; others allow separate reporting with appropriate modifier 59 or XS documentation.

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 (3.32) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (19.09) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	3.32
Practice expense RVU	15.07
Malpractice RVU	0.7
Total RVU	19.09
Medicare national rate	$637.62
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	$637.62
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI J8) Ambulatory surgical center (freestanding)	$1,173.60

Common denial reasons

The recurring reasons claims for CPT 28546 get rejected.

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

Missing laterality modifier LT or RT — payers routinely reject unilateral foot procedure claims without side designation
Upcoding flag when documentation doesn't establish medical necessity for anesthesia, making 28545 the appropriate code instead
Separate billing of fluoroscopic guidance without modifier 59 or XS when payer bundles imaging into the reduction
E/M services billed during the 90-day global without modifier 24 or 25, triggering bundling denial
ICD-10 code mismatch — using a general foot dislocation code instead of the specific tarsal bone dislocation code (e.g., S93.3xx series)

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What separates 28546 from 28545?

Anesthesia. Code 28545 covers closed treatment of the same non-talotarsal tarsal dislocation without anesthesia. If the patient required anesthesia — general, regional, or IV sedation — to tolerate manipulation, 28546 applies. Document the clinical reason anesthesia was necessary.

02Can I bill 28546 and 28555 together if I attempt closed reduction and then convert to open?

No. If you convert to open treatment in the same operative session, bill only 28555 (open treatment with internal fixation). The attempted closed reduction is bundled into the open procedure. If the closed reduction held but the patient returned on a separate date for open treatment, use modifier 58 on 28555.

03Does the 90-day global include the initial casting and follow-up X-rays?

Routine cast checks and dressing changes are bundled. Follow-up X-rays taken to assess healing are generally billable separately since imaging codes are not in the surgical global — but confirm with individual payer policy, as some commercial plans bundle them.

04How do I bill an unrelated procedure in the 90-day global period?

Use modifier 79 for an unrelated procedure performed by the same physician during the postoperative period. Use modifier 78 only if the patient returns to the OR for a procedure directly related to the original dislocation treatment. Do not invert these.

05Is modifier 22 ever appropriate for 28546?

Yes, but document the increased work explicitly — unusual anatomy, obesity significantly complicating the reduction, prolonged manipulation time, or associated soft tissue injury requiring additional attention. A brief reference to 'difficult reduction' without specifics will not support modifier 22 on audit.

06What ICD-10 codes pair with 28546?

The S93.3xx series covers dislocations of other and unspecified parts of the foot. Specify the exact tarsal joint when possible — for example, S93.321A (dislocation of navicular) or S93.301A for unspecified tarsal dislocation, initial encounter. Use the 'A' 7th character for active treatment.

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 involved, the anesthesia rationale, the reduction maneuver performed, pre- and post-reduction neurovascular exam findings, laterality, and immobilization details from dictation. This prevents the two most common audit flags: a vague operative note that defaults reviewers to 28545 (no anesthesia) and a missing laterality designation that triggers automatic claim rejection.

See how Mira captures CPT 28546 documentation