Percutaneous skeletal fixation of a tarsometatarsal (Lisfranc) joint dislocation, performed with closed manipulation and fluoroscopy-guided pin or screw insertion through the skin.

Verified May 8, 2026 · 6 sources ↓

Medicare: $387.12
Work RVU: 4.96
Global, days: 90
Region: Foot & ankle

Drawn from AAPCAacpmAbosGenhealthCMS

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 TMT joint(s) dislocated and fixed (e.g., first, second, third metatarsal-cuneiform, cuboid articulation).
Document the closed manipulation technique and confirm reduction was achieved prior to fixation.
Specify the fixation construct — screw vs. K-wire, number of implants, and percutaneous access points.
Record fluoroscopy use with intraoperative imaging confirming joint alignment before and after fixation.
Note anesthesia type (general or regional), as this distinguishes 28606 from the non-anesthesia code 28605.
Document pre-operative imaging (radiographs or CT) confirming dislocation diagnosis and any associated fracture fragments.

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 58 Staged or related 59 Distinct service 62 Co-surgeons 74 Discontinued post-anesthesia 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 28606 describes percutaneous fixation of a tarsometatarsal (TMT) joint dislocation — the classic Lisfranc injury pattern — where the surgeon manipulates the foot to restore alignment and drives screws or Kirschner wires through stab incisions under fluoroscopic guidance, without formal open arthrotomy. The code covers metatarsal-cuneiform and metatarsal-cuboid fixation at the TMT joint complex. Because the fracture fragments associated with a Lisfranc dislocation are stabilized by the same fixation construct, separate fracture-fixation coding is not warranted when the dislocation fixation achieves reduction of both.

Code 28606 sits in the middle of the TMT dislocation ladder: 28600 (closed, no anesthesia) and 28605 (closed, with anesthesia) are the non-fixation alternatives, while 28615 is the open treatment code when percutaneous fixation is inadequate or impossible. The 90-day global period applies. All routine post-op visits, dressing changes, cast or boot management, and hardware-removal planning within that window are bundled. Separate billing within the global requires modifier 24 (unrelated E/M) or 79 (unrelated procedure).

Site of service matters here. The HOPD and ASC payment rates differ materially — see the site-of-service comparison table on this page. Bilateral simultaneous fixation (rare but documented in high-energy trauma) requires modifier 50, and laterality modifiers LT/RT are standard when a single foot is treated.

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 (4.96) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (11.59) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	4.96
Practice expense RVU	5.71
Malpractice RVU	0.92
Total RVU	11.59
Medicare national rate	$387.12
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	$387.12
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 28606 get rejected.

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

Upcoding to 28615 (open treatment) flagged when operative note lacks evidence of arthrotomy — percutaneous access must be clearly documented.
Separate fracture-fixation code billed alongside 28606 when the dislocation fixation inherently stabilized the fracture fragments, triggering bundling denial.
Missing laterality modifier (LT or RT) causes claim rejection by Medicare and many commercial payers.
Global period violation — E/M or follow-up visit billed without modifier 24 within the 90-day post-op window.
ICD-10 mismatch: dislocation diagnosis code not mapped to a TMT joint (e.g., using a generic foot dislocation code instead of S93.3xx series).

Frequently asked questions

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

01Can I bill 28606 per joint when multiple TMT joints are fixed percutaneously?

The AAPC coding community guidance indicates 28606 is reported per joint for tarsometatarsal dislocations. When multiple TMT joints are addressed in the same session, bill 28606 for each joint with modifier 51 on the secondary units, and document each joint fixed individually in the operative note.

02What is the difference between 28606 and 28615?

28606 is percutaneous fixation — the skin is not formally opened and no arthrotomy is performed. 28615 is open treatment, which requires surgical exposure of the joint. If your operative note describes an incision for direct visualization of the TMT joint, 28615 applies. Payers audit this distinction closely.

03Should I bill the associated Lisfranc fracture separately when fixing the dislocation?

Generally no. When the dislocation fixation construct stabilizes associated fracture fragments at the same joint level, separate fracture-fixation coding is not supported. The AAPC wiki confirms that the fracture is considered addressed by the dislocation fixation.

04Does the 90-day global period include hardware removal?

Planned hardware removal within the global period is bundled. If hardware removal is unplanned (e.g., due to hardware failure or infection), use modifier 78 for a return to the OR for a related complication. Routine screw removal is not separately billable within the global.

05When does modifier 22 apply to 28606?

Modifier 22 is appropriate when the procedure is substantially more complex than typical — for example, severely comminuted injury pattern, morbid obesity requiring extended fluoroscopy time, or a failed prior reduction requiring re-manipulation. Document the additional work and operative time explicitly; payers require supporting notes to honor the modifier.

06What ICD-10 codes are typically paired with 28606?

The S93.3xx series covers dislocation of other and unspecified parts of the foot, and S93.32xA (dislocation of tarsometatarsal joint) is the primary match. Laterality suffixes (A for initial, D for subsequent) must align with the claim's date-of-service context. Mismatched or non-specific foot dislocation codes are a top denial trigger.

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) fixed, the manipulation sequence, fixation hardware type and count, fluoroscopy confirmation of reduction, and percutaneous access approach from dictation — preventing the most common audit flag: an operative note that says 'Lisfranc fixation performed' without specifying which metatarsal-cuneiform or cuboid articulations were addressed and how reduction was verified.

See how Mira captures CPT 28606 documentation