Open surgical repair of a tarsometatarsal (Lisfranc) joint dislocation, with or without internal or external fixation.

Verified May 8, 2026 · 7 sources ↓

Medicare: $793.27
Work RVU: 10.43
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCMdclarityFindacodeAAOS

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Identify each tarsometatarsal joint addressed and specify whether treatment was open or percutaneous for each joint
Document all incision sites separately — proximal metatarsal fractures at the Lisfranc level vs. mid-shaft fractures requiring distinct incisions
Specify fixation type used (screws, plates, external fixator, Kirschner wires) and confirm internal or external fixation placement in the body of the note
Record intraoperative fluoroscopic or stress X-ray findings confirming reduction and stability of each joint treated
Confirm mechanism of injury and pre-op imaging findings (plain films, CT) establishing dislocation diagnosis in the medical record
For multiple-joint cases, narrate each joint reduction separately so that per-unit billing of 28615 or 28606 is traceable to discrete operative steps

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 58 Staged or related 59 Distinct service 62 Co-surgeons LT Left side RT Right side 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

28615 covers open reduction of a tarsometatarsal joint dislocation — the Lisfranc joint complex — with or without the placement of internal or external fixation hardware. The code applies per joint addressed via open technique; when additional TMT joints are treated percutaneously in the same session, bill 28606 for those joints with modifier 59 to prevent bundling.

Associated proximal metatarsal fractures at the Lisfranc level are bundled into 28615 and cannot be billed separately using the tarsal fracture repair series. However, metatarsal shaft fractures treated through separate incisions are separately reportable — use 28485 with modifier 59 for each distinct fracture site and document each incision independently in the operative note.

Payer behavior on multiple TMT joints is inconsistent. The code descriptor omits the word 'each,' so some carriers pay only the first unit while others reimburse multiples. When billing more than one unit of 28615 or a combination of 28615 and 28606, append modifier 59 to subsequent lines and be prepared to submit the operative note on appeal. Digit-level toe modifiers (T codes) are used by some practices to differentiate joints, though carrier acceptance varies.

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 (10.43) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (23.75) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	10.43
Practice expense RVU	11.48
Malpractice RVU	1.84
Total RVU	23.75
Medicare national rate	$793.27
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	$793.27
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,682.29

Common denial reasons

The recurring reasons claims for CPT 28615 get rejected.

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

Bundling of 28615 with 28606 when multiple TMT joints are addressed — modifier 59 on the percutaneous line is missing
Separate billing of proximal metatarsal fracture repair (28485) for fractures at the Lisfranc level, which are included in 28615
Multiple units of 28615 denied because the descriptor lacks the word 'each' — operative note not submitted to support per-joint billing
Missing or mismatched ICD-10 diagnosis (S93.3xx series for Lisfranc dislocation) causing CPT-ICD mismatch rejection
Claim submitted without fluoroscopy or stress X-ray documentation when intraoperative imaging was billed as an additional service

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Can I bill 28615 multiple times if I treat more than one TMT joint open?

Yes, but payer acceptance varies. The code descriptor does not include 'each,' so some carriers pay only the first unit. Bill additional units with modifier 59 and be ready to submit the operative note on appeal with each joint's reduction narrated as a distinct step.

02When should I use 28606 instead of — or alongside — 28615?

Use 28606 for TMT joints treated by percutaneous skeletal fixation with manipulation. When the same operative session includes both open (28615) and percutaneous (28606) treatment of different joints, append modifier 59 to 28606 to prevent automatic bundling.

03Are proximal metatarsal fractures at the Lisfranc level separately billable?

No. Proximal metatarsal fractures associated with the Lisfranc dislocation are bundled into 28615 and cannot be billed separately using 28450–28485. Mid-shaft metatarsal fractures treated through distinct incisions are separately reportable with 28485-59 for each site.

04What is the global period for 28615 and what does it cover?

28615 carries a 90-day global period. That covers the surgery, the day-before pre-op visit, and all routine post-op care through day 90. Unrelated E/M services in that window require modifier 24; a separately identifiable E/M on the day of surgery requires modifier 25.

05Which ICD-10 codes support 28615?

Lisfranc (tarsometatarsal) dislocations map to the S93.3xx series — specify laterality (A/D/S for encounter type). Confirm the diagnosis code matches the operative site; a right-foot procedure billed against a left-foot ICD-10 will deny on first pass.

06Does 28615 differ in reimbursement between HOPD and ASC settings?

Yes — see the Site of Service comparison table on this page. The facility payment is meaningfully higher in the HOPD setting than in the ASC. For physicians billing the professional component only, the non-facility RVU applies regardless of setting.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the number of TMT joints treated, whether each was addressed via open or percutaneous technique, the specific fixation hardware used at each joint, and the presence of any metatarsal shaft fractures treated through separate incisions. That detail prevents the two most common denials on this code: bundling of 28615 with 28606 when multiple joints are involved, and incorrect inclusion of separately billable shaft fractures in the dislocation repair.

See how Mira captures CPT 28615 documentation