Closed treatment of a tarsometatarsal (Lisfranc) joint dislocation performed without anesthesia.

Verified May 8, 2026 · 6 sources ↓

Medicare: $190.39
Work RVU: 1.97
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCPayerpriceAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Explicitly state that no anesthesia (local, regional, or general) was used during the reduction
Identify the specific tarsometatarsal joint(s) involved and laterality (left vs. right foot)
Document pre- and post-reduction neurovascular status of the foot
Record the reduction technique and confirmation method (e.g., fluoroscopy, post-reduction clinical exam or imaging)
Note immobilization applied after reduction (splint, cast, buddy taping) and weight-bearing instructions
Include mechanism of injury and clinical findings supporting the dislocation diagnosis

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 52 Reduced services 58 Staged or related 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 6 cited references ↓

CPT 28600 covers manual closed reduction of a tarsometatarsal joint dislocation — the articulation between the five metatarsals and the tarsal bones (cuneiform and cuboid) at the midfoot — performed without any anesthesia. No incision is made; the physician manipulates the foot externally to restore joint alignment. The 90-day global period covers all routine post-reduction care including follow-up visits, dressing changes, and casting checks through day 90.

When anesthesia is required for the same closed reduction, report 28605 instead. If the dislocation requires open surgical correction, step up to 28615. Choosing the wrong code within this family is a common audit trigger — the operative or procedure note must explicitly state that no anesthesia was administered to support 28600 over 28605.

Place of service matters here. This procedure is billed from the office (POS 11) or emergency department (POS 23). Site-of-service payment differentials apply; see the Site of Service comparison table on this page. Laterality modifiers LT and RT are expected — omitting them on a single-foot procedure invites claim edits from many payers.

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 (1.97) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (5.7) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.97
Practice expense RVU	3.56
Malpractice RVU	0.17
Total RVU	5.7
Medicare national rate	$190.39
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	$190.39
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI P3) Ambulatory surgical center (freestanding)	$119.84

Common denial reasons

The recurring reasons claims for CPT 28600 get rejected.

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

Missing or incorrect laterality modifier — most payers require LT or RT on unilateral foot procedures
Anesthesia was documented in the note but 28600 (without anesthesia) was billed instead of 28605
Claim submitted without supporting imaging or objective findings confirming a true dislocation
Post-reduction visits billed separately during the 90-day global period without modifier 24 for unrelated conditions
Upcoding to 28615 (open treatment) when the procedure note describes a closed, non-surgical manipulation

Frequently asked questions

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

01What is the difference between 28600, 28605, and 28615?

28600 is closed reduction without anesthesia. 28605 is closed reduction requiring anesthesia. 28615 is open surgical treatment. Bill based on what was actually performed and documented — using the wrong code within this family is a top audit trigger.

02Do I need a laterality modifier for 28600?

Yes. Append LT or RT for a unilateral procedure. Most payers apply edits when laterality is absent on a foot code, and some MACs auto-deny without it.

03Can I bill an E/M visit on the same day as 28600?

Only if the E/M addresses a separate, distinct problem. Append modifier 25 to the E/M and document the separate medical decision-making. A routine pre-procedure assessment for the same dislocation is bundled into 28600.

04What does the 90-day global period include for 28600?

The global covers the procedure day, the day before (if a pre-op visit occurs), and all routine follow-up through day 90 — including office visits, cast checks, and dressing changes related to the dislocation. Bill unrelated visits with modifier 24.

05Is fluoroscopic guidance separately billable with 28600?

Imaging guidance used to confirm reduction is generally considered integral to the closed reduction and is not separately billable. Check your MAC's local coverage policy before appending a fluoroscopy code.

06Can 28600 be billed bilaterally in the same session?

Bilateral tarsometatarsal dislocations are rare but if both feet are treated, report 28600 twice with LT and RT on separate line items rather than modifier 50, unless your payer specifically requires 50. Verify payer preference before submitting.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the absence of anesthesia, the specific tarsometatarsal joint(s) reduced, laterality, pre- and post-reduction neurovascular exam findings, reduction technique, and immobilization applied — directly from your dictation. That prevents the most common denial pattern: a note that documents anesthesia use (or fails to document its absence) while 28600 is billed, triggering a downcode or audit flag for incorrect code selection within the 28600–28615 family.

See how Mira captures CPT 28600 documentation