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CPT code 28446: Talar lesion surgery, open treatment with autograft2026 Medicare rate & RVUs

Open surgery uses a bone-and-cartilage autograft to treat a focal osteochondral lesion of the talus, such as a symptomatic talar dome defect.

CMS RVU26DEffective Oct 1, 2026109 payment localities31 Medicare services in 2024

Medicare pays $1,125.61 for 28446 nationally in a facility.

Medicare rate · 28446

Talar lesion surgery, open treatment with autograft

Office or facility?

Work RVUs
17.27
Total RVUs
33.70
Global days
090

National rate · 2026

$1,125.61

Facility setting, before claim adjustments.

See every locality for 28446 →Billed by an NP, PA or therapist? →

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

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 28446 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 28446 covers

The surgeon exposes the talus, addresses the osteochondral defect by drilling and removing loose fragments as indicated, and places an autograft to restore the damaged surface. This is typically performed by an orthopedic foot and ankle surgeon in a hospital or ambulatory surgical setting for a symptomatic talar lesion, including lesions that need graft reconstruction rather than fracture fixation or arthroscopic treatment alone. The graft harvest is included in the service.

Report the code when the operative record supports open treatment of a talar osteochondral lesion with autograft. Document the lesion, open approach, work performed, and graft use; do not select it for open fixation of a talus fracture. Medicare assigns a 90-day global period, including the day before surgery and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 applies to bilateral reporting, with payment at 150%. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is 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.

Where 28446 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

28446 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,019.14
AlaskaUnavailable$1,386.69
ArizonaUnavailable$1,094.75
ArkansasUnavailable$1,006.06
Atlanta, GAUnavailable$1,158.80
Austin, TXUnavailable$1,137.51
Bakersfield, CAUnavailable$1,129.56
Baltimore area, MDUnavailable$1,195.00
Beaumont, TXUnavailable$1,078.55
Brazoria, TXUnavailable$1,099.42

28446 rates by state

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

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Local rates. Clear comparisons.

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

View every state and territory as a table
28446 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 28446 rate is calculated

Each of 28446’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 · 28446

RVUs × geographic indexes × conversion factor

Office or facility?

Work17.27

17.27 RVUs× 1.000 GPCI

Practice expense12.76

12.76 RVUs× 1.000 GPCI

Malpractice3.67

3.67 RVUs× 1.000 GPCI

Adjusted RVUs

33.7000

Conversion factor

$33.4009

Medicare rate

$1,125.61

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

Payment rules and modifiers for 28446

28446 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 28446

Talar lesion surgery, open treatment with autograft

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)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
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 · 28446

Talar lesion surgery, open treatment with autograft

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

28446 without 50 · national facility

$1,125.61

Talar lesion surgery, open treatment with autograft

28446-50 · Bilateral: 150%

$1,688.41

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

28446 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 28446

    Talar lesion surgery, open treatment with autograft17.27 wRVU

    Not priced

  • 28445

    Talus fracture surgery, open treatment15.37 wRVU

    Not priced

  • 29891

    Ankle arthroscopy, talus or tibia lesion9.43 wRVU

    Not priced

  • 29892

    Talar lesion repair, large talar dome lesion10.01 wRVU

    Not priced

How to choose

28445Talus fracture surgeryOpen treatment
28445 treats a talus fracture with open surgery. Choose 28446 for an osteochondral lesion treated with an autograft, not fracture fixation.
29891Ankle arthroscopyTalus or tibia lesion
29891 describes arthroscopic excision and drilling of an osteochondral defect; 28446 describes open treatment with autograft.
29892Talar lesion repairLarge talar dome lesion
29892 is for arthroscopic treatment of a talar osteochondritis dissecans lesion, with or without fixation. 28446 is the open autograft treatment.

Codes related to 28446

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

Codes related to 28446
CodeHow it relatesNational office range
Used instead
29891Ankle arthroscopy, talus or tibia lesionArthroscopic excision and drilling of a talar or tibial osteochondral defect.No office rate
29892Talar lesion repair, large talar dome lesionArthroscopic treatment of a talar osteochondritis dissecans lesion, with or without fixation.No office rate
Same family
28445Talus fracture surgery, open treatmentOpen talus surgery for fracture treatment, rather than osteochondral lesion grafting.No office rate

28446 billing questions

How is this different from open treatment of a talus fracture?

This code is for open graft treatment of an osteochondral lesion. Use the talus-fracture code when the operation treats a fracture rather than a focal cartilage-and-bone defect.

When would an arthroscopic talar lesion code be considered instead?

Consider the arthroscopic code that matches the documented lesion treatment when the surgeon works arthroscopically. This code describes open treatment with autograft.

Is graft harvest separately reported?

No. Obtaining the autograft is included in this service.

What documentation supports reporting this code?

The operative report should establish the talar osteochondral lesion, the open approach, the treatment performed, and use of an autograft.

How are bilateral procedures handled?

CMS lists this as a bilateral procedure; modifier 50 is paid at 150%.

What applies when other procedures are performed in the same session?

The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation.

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 28446PPRRVU2026_Oct_nonQPP.csv, line 3,207 (RVU26D)

Open CMS sourceHow we calculate rates

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