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CPT code 28450: Tarsal fracture care, without manipulation2026 Medicare rate & RVUs in Puerto Rico

Report 28450 for closed treatment of an individual tarsal bone fracture, such as a navicular or cuboid fracture, when no manipulation is performed.

CMS RVU26DEffective Oct 1, 2026One payment locality1.5K Medicare services in 2024

In Puerto Rico, Medicare pays $233.04 for 28450 in the office and $195.56 when it’s performed in a hospital or facility.

$233.04Office (non-facility)
$195.56Hospital or facility
+0.7%vs the national office rate ($231.47)

Check a contract rate as a % of Medicare · 28450 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 28450 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 28450 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 28450 covers

An orthopedist or podiatrist reports this service for definitive closed care of a tarsal bone fracture other than a talus or calcaneus fracture, when the bone is treated without manipulating it to restore alignment. Examples include navicular, cuboid, and cuneiform fractures. Care may involve immobilization and a treatment plan with follow-up in an office, emergency department, or facility setting.

Select the code for each tarsal bone treated, and document the specific bone, fracture, and that treatment did not involve manipulation. This code has a 90-day global period: the day-before preoperative visit and related postoperative care during that period are included. 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% multiple-procedure reduction. Modifier 50 is inappropriate; the code is reported by bone treated. Medicare does not pay an assistant at surgery, and 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 Puerto Rico compares for 28450

Across 109 of 109 payment localities, the office rate for 28450 runs from $204.94 in Arkansas to $303.35 in San Benito County, CA. Puerto Rico pays $233.04. The RVUs are the same everywhere; the geographic indexes change the dollars.

28450 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$233.04
  2. Los Angeles, CA · California$259.58+$26.54
  3. Washington, DC area · District of Columbia$263.86+$30.82
  4. Miami, FL · Florida$252.16+$19.12
  5. Chicago, IL · Illinois$244.82+$11.78
  6. Manhattan, NY · New York$266.45+$33.41
  7. Alaska · Alaska$270.47+$37.43

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

Every other payment area

28450 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$207.91$175.47
ArkansasArkansas$204.94$173.09
ArizonaArizona$225.29$189.36
Bakersfield, CACalifornia$244.04$203.41
Chico, CACalifornia$243.23$202.59
El Centro, CACalifornia$243.27$202.64
Fresno, CACalifornia$243.23$202.59
Hanford, CACalifornia$243.23$202.59

28450 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.

$204.94

$273.29

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

View every state and territory as a table
28450 office rate range by state
State / territoryOffice rate rangeLocalities
AK$270.471
AL$207.911
AR$204.941
AZ$225.291
CA$243.23–$303.3529
CO$240.201
CT$246.771
DC$263.861
DE$228.981
FL$229.31–$252.163
GA$216.42–$236.042
GU$248.901
HI$248.901
IA$212.571
ID$214.061
IL$223.16–$244.824
IN$215.271
KS$211.861
KY$213.361
LA$213.14–$223.542
MA$238.89–$263.412
MD$233.23–$263.863
ME$215.45–$226.612
MI$219.10–$232.422
MN$229.411
MO$209.70–$224.003
MS$207.351
MT$231.451
NC$217.641
ND$225.911
NE$213.641
NH$236.691
NJ$249.37–$261.232
NM$220.401
NV$230.061
NY$220.89–$273.205
OH$217.971
OK$212.691
OR$228.07–$247.452
PA$218.16–$240.862
PR$233.041
RI$236.861
SC$218.211
SD$225.261
TN$212.941
TX$216.77–$239.588
UT$221.161
VA$226.07–$263.862
VI$233.041
VT$225.291
WA$238.36–$268.472
WI$218.451
WV$215.071
WY$229.041

See 28450 in every payment locality

How the 28450 rate is calculated

Each of 28450’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 · 28450

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.98

1.98 RVUs× 1.000 GPCI

Practice expense4.67

4.67 RVUs× 1.000 GPCI

Malpractice0.28

0.28 RVUs× 1.000 GPCI

Adjusted RVUs

6.9300

Conversion factor

$33.4009

Medicare rate

$231.47

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

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

3,208

Code
28450
Physician work
1.98
Practice expense
4.67
Malpractice
0.28

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 28450 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work1.98× 1.0001.9800
Practice expense4.67× 1.0114.7214
Malpractice0.28× 0.9850.2758
Total RVUs6.9772
Conversion factor× 33.4009

Office rate, Puerto Rico$233.04

Office: (1.98 × 1 + 4.67 × 1.011 + 0.28 × 0.985) × $33.4009 = $233.04

Facility: (1.98 × 1 + 3.56 × 1.011 + 0.28 × 0.985) × $33.4009 = $195.56

Open 28450 in the RVU calculator

Payment rules and modifiers for 28450

28450 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 28450

Tarsal fracture care, without 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)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
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 · 28450

Tarsal fracture care, without 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 51 · payment effect

With and without the modifier

28450 without 51 · national office

$231.47

Tarsal fracture care, without manipulation

28450-51 · Second procedure: 50%

$115.74

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

Codes related to 28450

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

Codes related to 28450
CodeHow it relatesOffice range, Puerto Rico
Same family
28455Tarsal fracture care, each tarsal boneClosed treatment of a tarsal bone fracture when manipulation is performed.$261.67
Used instead
28456Tarsal fracture fixation, percutaneous, with manipulationPercutaneous skeletal fixation for a tarsal fracture treated with manipulation.No office rate
28465Tarsal fracture repair, open treatment, each boneOpen treatment of a tarsal bone fracture, rather than closed treatment without manipulation.No office rate

How 28450 has changed in Puerto Rico

28450 · Office / nonfacility

$233.04

Effective 2026-10-01

The base rate is $18.09 higher than on 2025-10-01, moving from $214.95 to $233.04 (8.4%).

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

    $214.95changed to$233.04

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.03 changed to 1.98
    • Practice expense RVU 4.31 changed to 4.67
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $219.20changed to$214.95

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 4.26 changed to 4.31
    • Malpractice RVU 0.27 changed to 0.28

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $215.62changed to$219.20

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $218.18changed to$215.62

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 4.11 changed to 4.26
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $217.22changed to$218.18

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $219.34changed to$217.22

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 4.00 changed to 4.11
    • Malpractice RVU 0.28 changed to 0.27
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $218.36changed to$219.34

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 3.94 changed to 4.00
    • Malpractice RVU 0.26 changed to 0.28

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $220.03changed to$218.36

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.76 changed to 3.94
    • Malpractice RVU 0.28 changed to 0.26
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $220.34changed to$220.03

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 3.79 changed to 3.76
    • Malpractice RVU 0.27 changed to 0.28
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $223.36changed to$220.34

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 3.88 changed to 3.79

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $197.89changed to$223.36

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 3.86 changed to 3.88
    • Malpractice RVU 0.28 changed to 0.27
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $173.41changed to$197.89

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 3.87 changed to 3.86
    • Malpractice RVU 0.29 changed to 0.28
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $173.78changed to$173.41

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 3.86 changed to 3.87

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $172.92changed to$173.78

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $170.73changed to$172.92

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 3.84 changed to 3.86
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $169.41changed to$170.73

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 4.24 changed to 3.84
    • Malpractice RVU 0.30 changed to 0.29
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $169.41

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$233.04$195.56RVU26D
2026-07-01$233.04$195.56RVU26C
2026-04-01$233.04$195.56RVU26B
2026-01-01$233.04$195.56RVU26A
2025-10-01$214.95$194.75RVU25D
2025-07-01$214.95$194.75RVU25C
2025-04-01$214.95$194.75RVU25B
2025-01-01$214.95$194.75RVU25A
2024-10-01$219.20$198.41RVU24D
2024-07-01$219.20$198.41RVU24C
2024-04-01$219.20$198.41RVU24B
2024-03-09$219.20$198.41RVU24AR
2024-01-01$215.62$195.18RVU24A
2023-10-01$218.18$197.35RVU23D
2023-07-01$217.22$196.55RVU23C
2023-04-01$217.22$196.55RVU23B
2023-01-01$217.22$196.55RVU23A
2022-10-01$219.34$198.06RVU22D
2022-07-01$219.34$198.06RVU22C
2022-04-01$219.34$198.06RVU22B
2022-01-01$219.34$198.06RVU22A
2021-10-01$218.36$196.55RVU21D
2021-07-01$218.36$196.55RVU21C
2021-04-01$218.36$196.55RVU21B
2021-01-01$218.36$196.55RVU21A
2020-10-01$220.03$198.20RVU20D
2020-07-01$220.03$198.20RVU20C
2020-04-01$220.03$198.20RVU20B
2020-01-01$220.03$198.20RVU20A
2019-10-01$220.34$197.84RVU19D
2019-07-01$220.34$197.84RVU19C
2019-04-01$220.34$197.84RVU19B
2019-01-01$220.34$197.84RVU19A
2018-10-01$223.36$197.98RVU18D
2018-07-01$223.36$197.98RVU18C
2018-04-01$223.36$197.98RVU18B
2018-01-01$223.36$197.98RVU18AR1
2017-10-01$197.89$177.30RVU17D
2017-07-01$197.89$177.30RVU17C
2017-04-01$197.89$177.30RVU17B
2017-01-01$197.89$177.30RVU17A
2016-10-01$173.41$156.50RVU16D
2016-07-01$173.41$156.50RVU16C
2016-04-01$173.41$156.50RVU16B
2016-01-01$173.41$156.50RVU16A
2015-10-01$173.78$156.81RVU15D
2015-07-01$173.78$156.81RVU15C
2015-04-01$172.92$156.03RVU15B
2015-01-01$172.92$156.03RVU15A
2014-10-01$170.73$154.12RVU14D
2014-07-01$170.73$154.12RVU14C
2014-04-01$170.73$154.12RVU14B
2014-01-01$170.73$154.12RVU14A
2013-10-01$169.41$152.11RVU13D
2013-07-01$169.41$152.11RVU13C
2013-04-01$169.41$152.11RVU13B
2013-01-01$169.41$152.11RVU13AR

Price 28450 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

28450 billing questions

How is 28450 different from 28455?

Both address closed treatment of a tarsal bone fracture other than the talus or calcaneus. Use 28450 when no manipulation is performed; 28455 is for treatment with manipulation.

How many units should be reported?

The code is reported for each tarsal bone treated. Document the bone involved and the treatment provided for each fracture.

Can modifier 50 be used for fractures on both sides?

No. Modifier 50 is inappropriate for this code; its descriptor identifies treatment by each bone.

Is related fracture follow-up separately reported during the global period?

The 90-day global period includes related postoperative care, as well as the day-before preoperative visit.

What documentation supports reporting 28450?

Document the specific tarsal bone and fracture, the closed treatment plan, and that no manipulation was performed.

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 28450PPRRVU2026_Oct_nonQPP.csv, line 3,208 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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