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CPT code 28476: Metatarsal fracture, percutaneous fixation with manipulation2026 Medicare rate & RVUs

Reports manipulation and percutaneous skeletal fixation of a metatarsal fracture when reduction and pin or wire stabilization are performed without open exposure.

CMS RVU26DEffective Oct 1, 2026109 payment localities409 Medicare services in 2024

Medicare pays $387.78 for 28476 nationally in a facility.

Medicare rate · 28476

Metatarsal fracture, percutaneous fixation with manipulation

Office or facility?

Work RVUs
3.51
Total RVUs
11.61
Global days
090

National rate · 2026

$387.78

Facility setting, before claim adjustments.

See every locality for 28476 →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 28476 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 28476 covers

An orthopedic or foot-and-ankle surgeon uses this service for a metatarsal fracture that needs manipulation to restore alignment and stabilization with pins or other percutaneous skeletal fixation, without open exposure of the fracture. It is generally performed in an operating room or other surgical facility for a displaced fracture requiring more than closed treatment alone. Report the service for each metatarsal fracture treated.

Choose this code when both manipulation and percutaneous fixation are performed; closed manipulation without skeletal fixation is represented by 28475, while open fixation is represented by 28485. Document the specific metatarsal, fracture pattern, reduction, fixation method, and imaging that supports the result. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documentation of 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.

Where 28476 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

28476 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$348.29
AlaskaUnavailable$454.55
ArizonaUnavailable$377.32
ArkansasUnavailable$343.32
Atlanta, GAUnavailable$395.86
Austin, TXUnavailable$400.55
Bakersfield, CAUnavailable$407.04
Baltimore area, MDUnavailable$412.42
Beaumont, TXUnavailable$363.78
Brazoria, TXUnavailable$382.41

28476 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
28476 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 28476 rate is calculated

Each of 28476’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 · 28476

RVUs × geographic indexes × conversion factor

Office or facility?

Work3.51

3.51 RVUs× 1.000 GPCI

Practice expense7.55

7.55 RVUs× 1.000 GPCI

Malpractice0.55

0.55 RVUs× 1.000 GPCI

Adjusted RVUs

11.6100

Conversion factor

$33.4009

Medicare rate

$387.78

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

Payment rules and modifiers for 28476

28476 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 28476

Metatarsal fracture, percutaneous fixation 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)0The 150% bilateral adjustment doesn’t apply.
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 · 28476

Metatarsal fracture, percutaneous fixation 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 51 · payment effect

With and without the modifier

28476 without 51 · national facility

$387.78

Metatarsal fracture, percutaneous fixation with manipulation

28476-51 · Second procedure: 50%

$193.89

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

28476 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 28476

    Metatarsal fracture, percutaneous fixation with manipulation3.51 wRVU

    Not priced

  • 28475

    Metatarsal fracture, closed reduction, each bone2.93 wRVU

    $275.89

  • 28470

    Metatarsal fracture care, without manipulation, each1.98 wRVU

    $237.15

  • 28485

    Metatarsal fracture surgery, open treatment, each7.25 wRVU

    Not priced

How to choose

28475Metatarsal fractureClosed reduction, each bone
Choose 28475 for closed treatment with manipulation but without percutaneous skeletal fixation. Use 28476 when pins or other percutaneous fixation are also performed.
28470Metatarsal fracture careWithout manipulation, each
28470 is for closed treatment without manipulation. 28476 includes manipulation and percutaneous skeletal fixation.
28485Metatarsal fracture surgeryOpen treatment, each
28485 represents open treatment of a metatarsal fracture. 28476 is for manipulation and percutaneous fixation without open exposure.

Codes related to 28476

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

Codes related to 28476
CodeHow it relatesNational office range
Same family
28475Metatarsal fracture, closed reduction, each boneClosed treatment of a metatarsal fracture with manipulation, without percutaneous skeletal fixation.$246.31–$353.54
28470Metatarsal fracture care, without manipulation, eachClosed treatment of a metatarsal fracture without manipulation.$209.70–$311.23
Used instead
28485Metatarsal fracture surgery, open treatment, eachOpen treatment with fixation is used when the fracture is treated through open exposure.No office rate
28456Tarsal fracture fixation, percutaneous, with manipulationPercutaneous fixation with manipulation for a tarsal fracture rather than a metatarsal fracture.No office rate

28476 billing questions

How does 28476 differ from 28475?

Use 28476 when the metatarsal fracture is manipulated and stabilized with percutaneous skeletal fixation. Code 28475 describes closed treatment with manipulation but without that fixation.

Is the fracture manipulation separately reported?

The manipulation used to reduce the same fracture is part of the 28476 service. Do not separately report closed manipulation for that fracture.

Can modifier 50 be used for fractures on both feet?

No. Modifier 50 is inappropriate for this code under the CMS bilateral rule. Report each treated metatarsal fracture as supported by the operative documentation.

How many units should be reported when more than one metatarsal is treated?

The code is reported for each metatarsal fracture treated. Document the bone and the manipulation and percutaneous fixation performed for each fracture.

What postoperative care is included in the global period?

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

When is assistant-at-surgery payment allowed?

Medicare allows assistant-at-surgery payment only when the record documents medical necessity. Co-surgeons and team surgery are not permitted for this service.

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 28476PPRRVU2026_Oct_nonQPP.csv, line 3,214 (RVU26D)

Open CMS sourceHow we calculate rates

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