Percutaneous skeletal fixation of a talotarsal joint dislocation, with manipulation to reduce the displaced joint.

Verified May 8, 2026 · 6 sources ↓

Medicare: $386.45
Work RVU: 4.49
Global, days: 90
Region: Foot & ankle

Drawn from CMSAcgmeAAPCAbos

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 talotarsal joint(s) dislocated (subtalar, talonavicular, or both) with imaging correlation
Confirm percutaneous approach — operative note must state hardware placed through skin without open arthrotomy
Document that manipulation was performed to reduce the dislocation prior to or concurrent with fixation
Specify type and number of fixation devices used (K-wires, screws) and final fluoroscopic confirmation of reduction
Record laterality (left vs. right foot) for modifier assignment
Note anesthesia type — distinguishes 28576 from closed reduction scenarios

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 57 Decision for surgery 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

28576 covers percutaneous pin or screw fixation of a talotarsal joint dislocation — meaning the talus has dislocated relative to one or more of the adjacent tarsal bones — combined with closed manipulation to reduce the joint. Hardware is placed through the skin without formal open exposure. The talotarsal articulations include the subtalar (talocalcaneal) and talonavicular joints; document which joint(s) are involved and confirm the operative note specifies percutaneous technique with manipulation.

This code sits in a family with distinct levels of intervention: 28575 is closed treatment requiring anesthesia (no fixation), 28576 adds percutaneous skeletal fixation, and 28585 is open treatment with internal fixation. Selecting the wrong level is the most common upcoding or downcoding error on these cases. The 90-day global period means all routine follow-up, hardware checks, and cast/splint changes within 90 days of the procedure are included — separate billing for those services requires modifier 24 or 25 and documentation that the visit addresses a problem unrelated to the dislocation.

Pay close attention to site-of-service. HOPD and ASC payment rates differ substantially (see the Site of Service comparison table). Most payers follow Medicare's NCCI bundling logic: if a cast or splint is applied as part of the same encounter, do not report casting/strapping codes separately — payment for immobilization supplies is bundled into the procedure payment.

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 (4.49) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (11.57) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	4.49
Practice expense RVU	6.12
Malpractice RVU	0.96
Total RVU	11.57
Medicare national rate	$386.45
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	$386.45
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 28576 get rejected.

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

Wrong code level selected — 28575 (closed, no fixation) or 28585 (open) billed when percutaneous fixation was actually performed
Missing laterality modifier LT or RT on the claim, triggering NCCI or payer edits
Casting or strapping code billed same-day without modifier 59; bundled into the procedure under NCCI policy
Routine post-op visits billed during the 90-day global period without modifier 24 or 25 and documentation of a separate, unrelated problem
ICD-10 diagnosis code does not specify laterality or does not match talotarsal dislocation anatomy, creating CPT-ICD mismatch

Frequently asked questions

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

01What separates 28576 from 28575 and 28585?

28575 is closed treatment requiring anesthesia with no hardware placed. 28576 adds percutaneous fixation (pins or screws through the skin) with manipulation. 28585 is open treatment requiring formal surgical exposure, with internal fixation. The operative note must support whichever level you bill — specifically whether hardware was placed and whether the approach was percutaneous or open.

02Does 28576 cover both subtalar and talonavicular dislocations?

Yes. The talotarsal articulation includes both the talocalcaneal (subtalar) and talonavicular joints. Document which joint or joints were dislocated and treated. If both joints are addressed in the same operative field as part of a single dislocation complex, one unit of 28576 is appropriate — don't unbundle by reporting separate codes for each joint surface.

03Can I bill a same-day E/M with 28576?

Only if the E/M is significant and separately identifiable from the decision to perform the procedure. Attach modifier 25 to the E/M and document the separate clinical decision-making. If the visit was purely pre-procedural evaluation for this dislocation, it's bundled into the global package.

04Can I bill casting or splinting separately the same day?

No. Per CMS NCCI policy, casting and strapping applied at the same encounter as a fracture or dislocation procedure are bundled into the procedure payment. Do not report a separate casting or strapping code for the same surgical encounter.

05What modifier applies if I return to the OR to remove the percutaneous hardware within 90 days?

Use modifier 78 if the return to the OR for hardware removal is related to the original dislocation procedure — an unplanned return within the global period for a related complication or planned stage. Use modifier 79 only if the second procedure is entirely unrelated to the talotarsal fixation. Do not invert these two modifiers.

06Is bilateral talotarsal dislocation ever coded with modifier 50?

Bilateral talotarsal dislocation is rare but if both feet are treated percutaneously in the same session, append modifier 50 and verify your payer's bilateral payment policy. Many payers apply a reduced payment for the second side. Document each foot's dislocation and fixation separately in the operative note.

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 talotarsal joint(s) involved, the percutaneous approach, manipulation performed, fixation device type and count, fluoroscopic reduction confirmation, and laterality directly from the surgeon's dictation. That structured capture prevents the most common audit flag on these cases: an operative note that documents open exposure or omits manipulation detail, forcing a code-level change on review.

See how Mira captures CPT 28576 documentation