Open surgical repair of a tarsal bone dislocation (excluding talotarsal joints), with or without internal fixation such as pins or screws.

Verified May 8, 2026 · 6 sources ↓

Medicare: $884.12
Total RVUs: 26.47
Global, days: 90
Region: Foot & ankle

Drawn from CMSFastrvuAAPCMdclarityAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify the specific tarsal bone(s) involved by name — navicular, cuboid, medial/intermediate/lateral cuneiform — and confirm no talotarsal joint is included.
Document the mechanism and direction of dislocation, pre-reduction imaging findings, and intraoperative confirmation of reduction.
Specify whether internal fixation was used and, if so, the hardware type (K-wire, screw, plate) and placement site.
Record the surgical approach by name; notes that read 'standard approach' or 'routine exposure' are audit flags.
Include intraoperative fluoroscopy findings or post-reduction imaging confirming anatomic alignment.
If modifier 22 is appended, the operative note must quantify the additional work — scarring, comminution, prior hardware, or neurovascular complexity — beyond the typical case.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 74 Discontinued post-anesthesia 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 28555 covers open treatment of a dislocation involving the tarsal bones of the midfoot or rearfoot — navicular, cuboid, or one of the three cuneiforms — excluding any joint where the talus is the proximal partner. The surgeon reduces the dislocation under direct visualization and may stabilize the construct with internal fixation hardware. Because the code is inclusive of fixation when used, do not separately bill hardware placement as a distinct service.

This carries a 90-day global period. That window covers the day-before decision visit (if modifier 57 is appended to the E/M), the operative day, and all routine follow-up through postoperative day 90. Any E/M visit unrelated to the foot dislocation during that window needs modifier 24. A staged return — for example, planned hardware removal or a second reconstruction — needs modifier 58, which resets the global clock.

Podiatry is the dominant billing specialty by volume. Orthopedic surgeons billing this code should confirm payer-specific credentialing and coverage policies, as some commercial payers apply specialty-based coverage edits to tarsal dislocation repair.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.41
Practice expense RVU	15.57
Malpractice RVU	1.49
Total RVU	26.47
Medicare national rate	$884.12
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	$884.12
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,297.57

Common denial reasons

The recurring reasons claims for CPT 28555 get rejected.

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

Talotarsal joint involvement documented in the operative note — those joints fall under different CPT codes and will trigger a mismatch denial.
ICD-10 diagnosis code does not lateralize or specify the tarsal bone, causing CPT-ICD mismatch on claim review.
Separate billing of internal fixation components that are bundled into 28555 under NCCI edits.
Missing modifier 57 on the same-day or day-before E/M when the decision for this major (90-day global) procedure was made at that visit.
Claim submitted without modifier LT or RT, causing payer rejection for laterality requirement on unilateral foot procedures.

Frequently asked questions

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

01Does 28555 include internal fixation, or should I bill that separately?

Internal fixation is included in 28555 when performed. Do not unbundle pin or screw placement as a separate line item — NCCI edits bundle standard fixation into the open dislocation repair.

02Can I bill 28555 for a Lisfranc dislocation?

Lisfranc (tarsometatarsal) dislocations are reported with 28615, not 28555. CPT 28555 is specifically for tarsal-to-tarsal dislocations excluding talotarsal joints. Using 28555 for a Lisfranc injury is a miscoded claim.

03What modifier do I use if I decide to operate the same day I see the patient in the ED or clinic?

Append modifier 57 to the E/M code when the decision for this surgery is made at that visit. Without 57, the E/M is bundled into the 90-day global and will be denied or recouped.

04The patient needs hardware removal in 6 weeks — what modifier applies?

If hardware removal is a planned, staged part of the treatment plan, append modifier 58 to the removal code. Document the intent in the original operative note. Modifier 58 resets the global period clock.

05How do I bill if the same patient has a related complication requiring return to the OR within the 90-day global?

Use modifier 78 for an unplanned return to the OR for a complication related to the original dislocation repair. Do not use modifier 79 — that is reserved for a procedure unrelated to the original surgery performed during the global period.

06Is modifier 50 appropriate if both feet have tarsal dislocations repaired at the same session?

Yes. Modifier 50 applies when the identical procedure is performed bilaterally in the same operative session. Most payers reimburse the bilateral add-on at 150% of the single-procedure rate, but confirm the specific payer's bilateral payment policy before submitting.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the specific tarsal bone dislocated, the surgical approach by name, reduction method, fixation hardware type and placement, and fluoroscopic confirmation of alignment — directly from dictation. This prevents the two most common audit flags: operative notes that omit the joint name and notes that fail to distinguish tarsal from talotarsal involvement, both of which generate medical necessity denials and downcoding.

See how Mira captures CPT 28555 documentation