CPT code 28446: Talar lesion surgery, open treatment with autograft2026 Medicare rate & RVUs in Texas
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 doesn’t publish an office rate for 28446 in Texas.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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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 in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | Unavailable | $1,137.51 |
| Beaumont, TX | Unavailable | $1,078.55 |
| Brazoria, TX | Unavailable | $1,099.42 |
| Dallas, TX | Unavailable | $1,111.69 |
| Fort Worth, TX | Unavailable | $1,109.02 |
| Galveston, TX | Unavailable | $1,106.16 |
| Houston, TX | Unavailable | $1,173.33 |
| Rest of Texas | Unavailable | $1,091.98 |
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
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share 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.
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).
28446 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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