Open surgical repair of a talotarsal joint dislocation, with or without internal fixation using pins or screws.

Verified May 8, 2026 · 6 sources ↓

Medicare: $948.92
Total RVUs: 28.41
Global, days: 90
Region: Foot & ankle

Drawn from CMSFastrvuAshlinkAAPC

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 involved (e.g., subtalar, talonavicular, calcaneocuboid) — 'talotarsal dislocation' alone is insufficient for audit defense.
Document whether internal fixation was used and, if so, specify the hardware type (pins, screws, wires) and placement.
Operative note must confirm open approach with direct visualization of the joint; closed reduction maps to a different code family.
Pre-operative imaging (X-ray or CT) confirming the dislocation with radiologist or surgeon interpretation on file.
ICD-10 diagnosis code must specify the correct tarsal joint and laterality — use LT or RT modifier on the claim accordingly.
Anesthesia type and intraoperative fluoroscopy use, if applicable, should be documented to support any separately billed services.

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 62 Co-surgeons 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 28585 covers open treatment of a dislocation at any talotarsal joint — meaning the articulation between the talus and one of the other six tarsal bones (calcaneus, navicular, cuboid, or one of the three cuneiforms). The surgeon opens the joint, reduces the dislocation under direct visualization, and may stabilize the construct with internal fixation hardware such as pins, screws, or wires. Whether fixation is used or not, the same code applies.

This is a 90-day global procedure. The global package absorbs the day-before visit, the surgery itself, and all routine post-operative care through day 90 — including hardware checks, wound care, and cast or splint management tied to the same injury. Any separately identifiable E/M for an unrelated condition during that window requires modifier 24. A significant, separately identifiable E/M on the day of surgery requires modifier 25.

Site of service matters here. The HOPD and ASC facility payments differ substantially — see the site-of-service comparison on this page. When choosing the surgical venue, factor in both clinical needs and payment differential, as payers apply different facility rates.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.85
Practice expense RVU	16.05
Malpractice RVU	1.51
Total RVU	28.41
Medicare national rate	$948.92
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	$948.92
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,290.57

Common denial reasons

The recurring reasons claims for CPT 28585 get rejected.

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

Wrong code family selected — closed reduction codes (e.g., 28570, 28575) submitted when open treatment was performed, or vice versa.
Laterality mismatch between the operative note and the ICD-10 code submitted on the claim.
Bundling denial when fluoroscopy or imaging guidance is billed separately without confirming payer policy on separate payment.
Missing or vague operative note that omits the approach, joint identified, and fixation decision — triggers medical necessity review.
Post-op E/M visits billed without modifier 24 during the 90-day global period, resulting in automatic denial.

Frequently asked questions

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

01Does 28585 include internal fixation, or do I bill hardware separately?

Internal fixation is included in 28585 regardless of whether it was used. You cannot separately bill pins, screws, or wire placement for the same talotarsal joint reduction. Hardware removal later in a separate encounter is separately billable.

02What is the global period for 28585?

90 days. All routine post-op care — wound checks, cast changes, suture removal, and hardware monitoring related to the dislocation repair — is bundled. Unrelated E/M services during that window need modifier 24.

03Which modifier do I use for the same foot, different joint, same session?

If you're repairing a dislocation at a second distinct talotarsal joint in the same operative session, append modifier 59 or XS to the additional procedure to indicate a distinct anatomical site. Confirm NCCI edit status before billing.

04Can I bill an E/M on the same day as 28585?

Only if it's a significant, separately identifiable evaluation unrelated to the decision to perform surgery. Use modifier 25 if the decision for surgery was made at a prior encounter, or modifier 57 if this E/M is the visit where the decision to perform a major procedure was made.

05What ICD-10 codes typically support 28585?

Traumatic dislocation codes in the S93 category (e.g., S93.3x for dislocation of other and unspecified parts of foot) are the primary diagnostic support. Specify laterality. Peritalar and subtalar dislocations also map here. Confirm the joint matches the operative note.

06How does site of service affect payment for 28585?

HOPD and ASC facility payments differ — see the site-of-service table on this page. The physician work RVU is the same regardless of where the case is performed, but the total non-facility vs. facility RVU split affects your reimbursement if billing from an office-based surgical suite.

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 talotarsal joint reduced, the open approach, whether internal fixation was placed and the hardware type, and intraoperative fluoroscopy use — all from dictation. That prevents the most common audit flag for 28585: an operative note that says 'open reduction of foot dislocation' without naming the joint or confirming direct visualization, which payers treat as insufficient to support the code.

See how Mira captures CPT 28585 documentation