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CPT code 28435: Talus fracture care, closed treatment with manipulation2026 Medicare rate & RVUs in Houston, TX

Reports closed reduction of a talus fracture when the clinician manipulates the fracture to improve alignment without open exposure or percutaneous fixation.

CMS RVU26DEffective Oct 1, 2026One payment locality103 Medicare services in 2024

In Houston, TX, Medicare pays $422.01 for 28435 in the office and $337.76 when it’s performed in a hospital or facility.

$422.01Office (non-facility)
$337.76Hospital or facility
+2.0%vs the national office rate ($413.84)

Check a contract rate as a % of Medicare · 28435 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 28435 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Houston, TX
  2. What 28435 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 28435 covers

An orthopedic surgeon or foot and ankle specialist uses external manipulation to restore alignment of a talus fracture, commonly when displacement requires reduction but treatment can remain closed. The service may be performed in a hospital or ambulatory setting, with imaging used to assess the fracture and confirm the result. The fracture is then managed with appropriate immobilization and follow-up.

Choose this code when the clinician performs manipulation as part of closed fracture treatment; document the talus fracture, the reduction maneuver, and the resulting alignment. Do not use it for treatment without manipulation or when percutaneous fixation or open reduction is performed. The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Houston, TX compares for 28435

Across 109 of 109 payment localities, the office rate for 28435 runs from $363.35 in Arkansas to $536.41 in San Benito County, CA. Houston, TX pays $422.01. The RVUs are the same everywhere; the geographic indexes change the dollars.

28435 in Houston, TX vs other payment areas
  1. Houston, TX · this page$422.01
  2. Austin, TX · Texas$427.19+$5.18
  3. Beaumont, TX · Texas$387.43−$34.58
  4. Brazoria, TX · Texas$406.93−$15.08
  5. Dallas, TX · Texas$410.32−$11.69
  6. Fort Worth, TX · Texas$407.89−$14.12
  7. Galveston, TX · Texas$408.65−$13.36

Other areas in Texas first, then benchmark localities. Bars start at $0.

Every other payment area

28435 in every other Medicare payment locality
Payment localityOfficeFacility
Rest of TexasTexas$397.49$316.98
Los Angeles, CACalifornia$460.55$360.19
Washington, DC areaDistrict of Columbia$471.63$371.69
Miami, FLFlorida$462.36$374.04
Chicago, ILIllinois$447.59$362.33
Manhattan, NYNew York$479.92$381.34
AlaskaAlaska$478.33$387.98
AlabamaAlabama$368.98$294.74

28435 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$363.35

$483.61

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
28435 office rate range by state
State / territoryOffice rate rangeLocalities
AK$478.331
AL$368.981
AR$363.351
AZ$401.831
CA$430.81–$536.4129
CO$427.431
CT$442.381
DC$471.631
DE$408.661
FL$414.04–$462.363
GA$388.90–$423.472
GU$441.141
HI$441.141
IA$375.831
ID$379.051
IL$403.71–$447.594
IN$381.291
KS$375.421
KY$381.331
LA$381.28–$400.972
MA$425.26–$469.082
MD$416.28–$471.633
ME$382.68–$402.372
MI$393.13–$420.972
MN$404.621
MO$375.36–$400.723
MS$369.361
MT$413.791
NC$386.661
ND$399.351
NE$377.561
NH$422.031
NJ$446.04–$466.632
NM$395.981
NV$410.041
NY$392.88–$493.945
OH$390.171
OK$379.061
OR$405.50–$439.882
PA$390.01–$431.862
PR$416.491
RI$422.441
SC$389.341
SD$397.651
TN$377.591
TX$387.43–$427.198
UT$394.901
VA$402.01–$471.632
VI$416.491
VT$399.051
WA$424.04–$477.392
WI$385.451
WV$388.421
WY$407.501

See 28435 in every payment locality

How the 28435 rate is calculated

Each of 28435’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 28435

RVUs × geographic indexes × conversion factor

Office or facility?

Work3.45

3.45 RVUs× 1.000 GPCI

Practice expense8.21

8.21 RVUs× 1.000 GPCI

Malpractice0.73

0.73 RVUs× 1.000 GPCI

Adjusted RVUs

12.3900

Conversion factor

$33.4009

Medicare rate

$413.84

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Houston, TX inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

3,204

Code
28435
Physician work
3.45
Practice expense
8.21
Malpractice
0.73

GPCI2026.csv

102

Locality
Houston, TX
Physician work
1.008
Practice expense
0.993
Malpractice
1.376
Office calculation for 28435 in Houston, TX
ComponentRVULocality factorAdjusted
Physician work3.45× 1.0083.4776
Practice expense8.21× 0.9938.1525
Malpractice0.73× 1.3761.0045
Total RVUs12.6346
Conversion factor× 33.4009

Office rate, Houston, TX$422.01

Office: (3.45 × 1.008 + 8.21 × 0.993 + 0.73 × 1.376) × $33.4009 = $422.01

Facility: (3.45 × 1.008 + 5.67 × 0.993 + 0.73 × 1.376) × $33.4009 = $337.76

Open 28435 in the RVU calculator

Payment rules and modifiers for 28435

28435 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 28435

Talus fracture care, closed treatment with manipulation

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.69/0.21Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 28435

Talus fracture care, closed treatment with manipulation

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

28435 without 50 · national office

$413.84

Talus fracture care, closed treatment with manipulation

28435-50 · Bilateral: 150%

$620.76

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

Codes related to 28435

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 28435
CodeHow it relatesOffice range, Houston, TX
Same family
28430Talus fracture care, without manipulationClosed talus fracture treatment without manipulation.$269.83
Used instead
28436Talus fracture fixation, percutaneous, with manipulationUsed when percutaneous skeletal fixation accompanies manipulation.No office rate
28445Talus fracture surgery, open treatmentUsed for open reduction and internal fixation of a talus fracture.No office rate

How 28435 has changed in Houston, TX

28435 · Office / nonfacility

$422.01

Effective 2026-10-01

The base rate is $33.98 higher than on 2025-10-01, moving from $388.03 to $422.01 (8.8%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $388.03changed to$422.01

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.54 changed to 3.45
    • Practice expense RVU 7.37 changed to 8.21
    • Malpractice RVU 0.72 changed to 0.73
    • Work GPCI 1.014 changed to 1.008
    • Practice expense GPCI 1.003 changed to 0.993
    • Malpractice GPCI 1.409 changed to 1.376

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $395.45changed to$388.03

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 7.24 changed to 7.37
    • Malpractice RVU 0.73 changed to 0.72

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $389.00changed to$395.45

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $394.29changed to$389.00

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 7.07 changed to 7.24
    • Malpractice RVU 0.72 changed to 0.73
    • Work GPCI 1.023 changed to 1.014
    • Practice expense GPCI 1.016 changed to 1.003
    • Malpractice GPCI 1.154 changed to 1.409

  5. January 1, 2023

    RVU23A

    $391.67changed to$394.29

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 6.81 changed to 7.07
    • Malpractice RVU 0.73 changed to 0.72
    • Work GPCI 1.032 changed to 1.023
    • Practice expense GPCI 1.029 changed to 1.016
    • Malpractice GPCI 0.900 changed to 1.154

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $351.02changed to$391.67

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 5.71 changed to 6.81
    • Malpractice RVU 0.59 changed to 0.73

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $383.31changed to$351.02

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 6.24 changed to 5.71
    • Malpractice RVU 0.68 changed to 0.59
    • Work GPCI 1.026 changed to 1.032
    • Practice expense GPCI 1.020 changed to 1.029
    • Malpractice GPCI 0.918 changed to 0.900

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $379.81changed to$383.31

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 6.18 changed to 6.24
    • Malpractice RVU 0.72 changed to 0.68
    • Work GPCI 1.020 changed to 1.026
    • Practice expense GPCI 1.012 changed to 1.020
    • Malpractice GPCI 0.936 changed to 0.918

    Held through RVU20B, RVU20C, RVU20D.

  9. July 1, 2019

    RVU19C

    $379.47changed to$379.81

    • Malpractice RVU 0.71 changed to 0.72

    Held through RVU19D.

  10. January 1, 2019

    RVU19A

    $378.30changed to$379.47

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 6.15 changed to 6.18
    • Malpractice RVU 0.72 changed to 0.71

    Held through RVU19B.

  11. January 1, 2018

    RVU18AR1

    $333.35changed to$378.30

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 5.13 changed to 6.15
    • Malpractice RVU 0.53 changed to 0.72
    • Practice expense GPCI 1.009 changed to 1.012
    • Malpractice GPCI 0.946 changed to 0.936

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $329.23changed to$333.35

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 5.08 changed to 5.13
    • Malpractice RVU 0.50 changed to 0.53
    • Work GPCI 1.019 changed to 1.020
    • Practice expense GPCI 1.006 changed to 1.009
    • Malpractice GPCI 0.955 changed to 0.946

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $335.76changed to$329.23

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 5.00 changed to 5.08
    • Malpractice RVU 0.74 changed to 0.50

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $334.09changed to$335.76

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $333.86changed to$334.09

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 5.09 changed to 5.00
    • Malpractice RVU 0.66 changed to 0.74
    • Work GPCI 1.014 changed to 1.019
    • Practice expense GPCI 1.004 changed to 1.006
    • Malpractice GPCI 0.939 changed to 0.955

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $368.88changed to$333.86

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 6.62 changed to 5.09
    • Malpractice RVU 0.69 changed to 0.66
    • Work GPCI 1.009 changed to 1.014
    • Practice expense GPCI 1.002 changed to 1.004
    • Malpractice GPCI 0.923 changed to 0.939

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $368.88

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$422.01$337.76RVU26D
2026-07-01$422.01$337.76RVU26C
2026-04-01$422.01$337.76RVU26B
2026-01-01$422.01$337.76RVU26A
2025-10-01$388.03$345.53RVU25D
2025-07-01$388.03$345.53RVU25C
2025-04-01$388.03$345.53RVU25B
2025-01-01$388.03$345.53RVU25A
2024-10-01$395.45$351.71RVU24D
2024-07-01$395.45$351.71RVU24C
2024-04-01$395.45$351.71RVU24B
2024-03-09$395.45$351.71RVU24AR
2024-01-01$389.00$345.97RVU24A
2023-10-01$394.29$349.53RVU23D
2023-07-01$394.29$349.53RVU23C
2023-04-01$394.29$349.53RVU23B
2023-01-01$394.29$349.53RVU23A
2022-10-01$391.67$346.80RVU22D
2022-07-01$391.67$346.80RVU22C
2022-04-01$391.67$346.80RVU22B
2022-01-01$391.67$346.80RVU22A
2021-10-01$351.02$310.09RVU21D
2021-07-01$351.02$310.09RVU21C
2021-04-01$351.02$310.09RVU21B
2021-01-01$351.02$310.09RVU21A
2020-10-01$383.31$340.98RVU20D
2020-07-01$383.31$340.98RVU20C
2020-04-01$383.31$340.98RVU20B
2020-01-01$383.31$340.98RVU20A
2019-10-01$379.81$337.87RVU19D
2019-07-01$379.81$337.87RVU19C
2019-04-01$379.47$337.53RVU19B
2019-01-01$379.47$337.53RVU19A
2018-10-01$378.30$336.77RVU18D
2018-07-01$378.30$336.77RVU18C
2018-04-01$378.30$336.77RVU18B
2018-01-01$378.30$336.77RVU18AR1
2017-10-01$333.35$298.22RVU17D
2017-07-01$333.35$298.22RVU17C
2017-04-01$333.35$298.22RVU17B
2017-01-01$333.35$298.22RVU17A
2016-10-01$329.23$294.29RVU16D
2016-07-01$329.23$294.29RVU16C
2016-04-01$329.23$294.29RVU16B
2016-01-01$329.23$294.29RVU16A
2015-10-01$335.76$301.06RVU15D
2015-07-01$335.76$301.06RVU15C
2015-04-01$334.09$299.56RVU15B
2015-01-01$334.09$299.56RVU15A
2014-10-01$333.86$298.97RVU14D
2014-07-01$333.86$298.97RVU14C
2014-04-01$333.86$298.97RVU14B
2014-01-01$333.86$298.97RVU14A
2013-10-01$368.88$328.31RVU13D
2013-07-01$368.88$328.31RVU13C
2013-04-01$368.88$328.31RVU13B
2013-01-01$368.88$328.31RVU13AR

Price 28435 for an earlier date of service

Where the Houston, TX rate applies

Houston, TX is a Medicare payment area, not a city. Our Census mapping connects it to 46 cities and communities in Texas. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in Texas

28435 billing questions

When is 28435 chosen instead of 28430?

Use 28435 when the clinician manipulates the talus fracture to improve alignment. Code 28430 describes closed treatment without manipulation.

How does 28435 differ from percutaneous fixation?

This code describes reduction through external manipulation without percutaneous skeletal fixation. Use 28436 when percutaneous skeletal fixation is performed.

What documentation supports 28435?

Document the talus fracture, the manipulation or reduction performed, and the resulting alignment. The record should also make clear whether treatment remained closed or involved fixation or open reduction.

Are related postoperative visits included?

The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted for this code.

How is bilateral treatment reported?

When the procedure is performed bilaterally, report modifier 50; CMS pays the bilateral procedure at 150%.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 28435PPRRVU2026_Oct_nonQPP.csv, line 3,204 (RVU26D)
Geographic factors for Houston, TXGPCI2026.csv, line 102 (RVU26D)

Open CMS sourceHow we calculate rates

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