Closed reduction of a tarsometatarsal (Lisfranc) joint dislocation performed under anesthesia, without surgical opening of the joint.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $383.78
- Work RVU
- 2.82
- Global, days
- 90
- Region
- Foot & ankle
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 5 cited references ↓
- Specify which tarsometatarsal joint(s) were dislocated and reduced — document joint levels by name (e.g., first, second, third TMT joint).
- Confirm anesthesia type used; the code descriptor requires anesthesia and its absence is an audit trigger.
- State the closed nature of the reduction explicitly — operative or procedure note must confirm no incision was made.
- Identify the foot (left or right) to support LT/RT modifier assignment.
- Document the pre- and post-reduction neurovascular status and imaging confirming reduction.
- Record mechanism of injury and clinical findings that establish the dislocation diagnosis, supporting the ICD-10 linkage.
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 5 cited references ↓
CPT 28605 covers closed treatment of a tarsometatarsal joint dislocation — the Lisfranc joint complex — performed with anesthesia. The tarsometatarsal articulations connect the five metatarsals to the cuneiform and cuboid bones; dislocation at this level is mechanically significant and almost always requires anesthesia to achieve adequate reduction. The code is specific to the closed approach: no incision, no internal fixation. If the surgeon opens the joint or places hardware, a different code applies.
This code carries a 90-day global period. All routine follow-up, casting checks, and dressing changes within that window are bundled. Bill unrelated E/M visits with modifier 24. If a complication requires a return to the OR for a related procedure within the global, append modifier 78. Laterality modifiers LT and RT apply when the operative report specifies the affected foot — document it explicitly.
Site of service matters here: HOPD and ASC reimbursements differ meaningfully (see the Site of Service comparison table). Cases performed in the office setting are rare given the anesthesia requirement, but if you bill a facility-based case, confirm the place-of-service code matches the claim.
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 (2.82) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (11.49) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 2.82 |
| Practice expense RVU | 8.08 |
| Malpractice RVU | 0.59 |
| Total RVU | 11.49 |
| Medicare national rate | $383.78 |
| 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 | $383.78 |
HOPD (APC 5111) Hospital outpatient department | $252.01 |
ASC (PI A2) Ambulatory surgical center (freestanding) | $135.54 |
Common denial reasons
The recurring reasons claims for CPT 28605 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing or unsupported anesthesia documentation — payers require explicit confirmation that anesthesia was administered for this code.
- ICD-10 mismatch: tarsometatarsal dislocation diagnosis code not linked or coded to the correct laterality on the claim.
- Unbundling of post-reduction casting or strapping within the 90-day global period without a compliant modifier.
- Laterality modifier absent or contradicts operative report when bilateral involvement is documented.
- Procedure billed as open reduction (different code family) but documented as closed, or vice versa — code-to-documentation mismatch triggers medical review.
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01Does 28605 require anesthesia to bill correctly?
02What's the difference between 28605 and the open reduction code for tarsometatarsal dislocation?
03Can I bill an E/M visit on the same day as 28605?
04How do I handle a same-day casting or strapping with 28605?
05If the patient returns to the OR within the global period for fixation of the same joint, what modifier applies?
06Is bilateral tarsometatarsal dislocation reduction on the same day billable with modifier 50?
07What ICD-10 codes typically support 28605?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
Mira Scribe
Mira's AI scribe captures the joint level(s) reduced, the closed approach, anesthesia type administered, pre- and post-reduction neurovascular exam findings, and laterality from dictation. This prevents the two most common 28605 denials: a missing anesthesia reference that triggers downcoding or rejection, and an absent laterality designation that blocks LT/RT modifier assignment at claim submission.
See how Mira captures CPT 28605 documentation