Billing code 28435: Talus fracture careMedicare rate & RVUs
Reports closed reduction of a talus fracture when the clinician manipulates the fracture to improve alignment without open exposure or percutaneous fixation.
Medicare pays $413.84 for 28435 nationally in the office and $329.00 in a hospital or facility. Local office rates run $363.35–$536.41.
Medicare rate · 28435
Talus fracture care
- Work RVUs
- 3.45
- Total RVUs
- 12.39
- Global days
- 090
National rate · 2026
$413.84
Office setting, before claim adjustments.
See every locality for 28435 →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.
On this page 10 sections
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.
Where 28435 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$363.35 to $536.41
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $368.98 | $294.74 |
| Alaska* | $478.33 | $387.98 |
| Arizona | $401.83 | $319.62 |
| Arkansas | $363.35 | $290.47 |
| Atlanta | $423.47 | $337.28 |
| Austin | $427.19 | $337.43 |
| Bakersfield | $432.82 | $339.84 |
| Baltimore/Surr. Cntys | $441.48 | $350.45 |
| Beaumont | $387.43 | $310.22 |
| Brazoria | $406.93 | $322.85 |
| Chicago | $447.59 | $362.33 |
| Chico | $430.81 | $337.83 |
| Colorado | $427.43 | $337.16 |
| Connecticut | $442.38 | $351.01 |
| Dallas | $410.32 | $325.82 |
| Dc + Md/Va Suburbs | $471.63 | $371.69 |
| Delaware | $408.66 | $324.84 |
| Detroit | $420.97 | $339.10 |
| East St. Louis | $416.62 | $338.57 |
| El Centro | $430.93 | $337.95 |
| Fort Lauderdale | $437.10 | $351.16 |
| Fort Worth | $407.89 | $324.24 |
| Fresno | $430.81 | $337.83 |
| Galveston | $408.65 | $324.40 |
| Hanford-Corcoran | $430.81 | $337.83 |
| Hawaii, Guam | $441.14 | $344.68 |
| Houston | $422.01 | $337.76 |
| Idaho | $379.05 | $301.00 |
| Indiana | $381.29 | $302.64 |
| Iowa | $375.83 | $298.20 |
| Kansas | $375.42 | $298.72 |
| Kentucky | $381.33 | $305.90 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $460.55 | $360.19 |
| Madera | $430.81 | $337.83 |
| Manhattan | $479.92 | $381.34 |
| Merced | $430.81 | $337.83 |
| Metropolitan Boston | $469.08 | $367.78 |
| Metropolitan Kansas City | $396.55 | $316.89 |
| Metropolitan Philadelphia | $431.86 | $343.54 |
| Metropolitan St. Louis | $400.72 | $319.96 |
| Miami | $462.36 | $374.04 |
| Minnesota | $404.62 | $317.33 |
| Mississippi | $369.36 | $296.31 |
| Modesto | $430.81 | $337.83 |
| Montana** | $413.79 | $328.95 |
| Napa | $496.30 | $384.49 |
| Nebraska | $377.56 | $299.25 |
| Nevada** | $410.04 | $325.12 |
| New Hampshire | $422.03 | $333.72 |
| New Mexico | $395.98 | $318.18 |
| New Orleans | $400.97 | $321.14 |
| North Carolina | $386.66 | $307.51 |
| North Dakota** | $399.35 | $314.52 |
| Northern Nj | $466.63 | $368.22 |
| Nyc Suburbs/Long Island | $493.94 | $393.06 |
| Ohio | $390.17 | $312.72 |
| Oklahoma | $379.06 | $303.30 |
| Oxnard-Thousand Oaks-Ventura | $457.78 | $357.50 |
| Portland | $439.88 | $345.62 |
| Poughkpsie/N Nyc Suburbs | $450.19 | $357.30 |
| Puerto Rico | $416.49 | $330.72 |
| Queens | $481.90 | $381.62 |
| Redding | $430.81 | $337.83 |
| Rest Of California | $430.81 | $337.83 |
| Rest Of Florida | $414.04 | $332.93 |
| Rest Of Georgia | $388.90 | $313.23 |
| Rest Of Illinois | $403.71 | $326.25 |
| Rest Of Louisiana | $381.28 | $306.20 |
| Rest Of Maine | $382.68 | $304.63 |
| Rest Of Maryland | $416.28 | $330.42 |
| Rest Of Massachusetts | $425.26 | $335.93 |
| Rest Of Michigan | $393.13 | $315.67 |
| Rest Of Missouri | $375.36 | $302.23 |
| Rest Of New Jersey | $446.04 | $353.40 |
| Rest Of New York | $392.88 | $312.29 |
| Rest Of Oregon | $405.50 | $321.00 |
| Rest Of Pennsylvania | $390.01 | $312.13 |
| Rest Of Texas | $397.49 | $316.98 |
| Rest Of Washington | $424.04 | $334.71 |
| Rhode Island | $422.44 | $334.80 |
| Riverside-San Bernardino-Ontario | $438.65 | $345.67 |
| Sacramento-Roseville-Folsom | $451.37 | $352.70 |
| Salinas | $449.70 | $351.37 |
| San Diego-Chula Vista-Carlsbad | $459.87 | $358.41 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $524.02 | $404.40 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $523.20 | $403.57 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $536.41 | $414.07 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $533.02 | $410.68 |
| San Luis Obispo-Paso Robles | $442.60 | $345.97 |
| Santa Cruz-Watsonville | $463.90 | $360.82 |
| Santa Maria-Santa Barbara | $451.27 | $352.35 |
| Santa Rosa-Petaluma | $468.50 | $364.32 |
| Seattle (King Cnty) | $477.39 | $373.29 |
| South Carolina | $389.34 | $310.95 |
| South Dakota** | $397.65 | $312.81 |
| Southern Maine | $402.37 | $318.30 |
| Stockton | $430.81 | $337.83 |
| Suburban Chicago | $440.87 | $353.74 |
| Tennessee | $377.59 | $300.48 |
| Utah | $394.90 | $315.15 |
| Vallejo | $495.11 | $383.29 |
| Vermont | $399.05 | $315.06 |
| Virgin Islands | $416.49 | $330.72 |
| Virginia | $402.01 | $318.61 |
| Visalia | $430.81 | $337.83 |
| West Virginia | $388.42 | $314.70 |
| Wisconsin | $385.45 | $304.17 |
| Wyoming** | $407.50 | $322.66 |
| Yuba City | $430.81 | $337.83 |
28435 rates by state
Office rate range in each state. Select a state to see its payment localities.
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $478.33 | 1 |
| AL | $368.98 | 1 |
| AR | $363.35 | 1 |
| AZ | $401.83 | 1 |
| CA | $430.81–$536.41 | 29 |
| CO | $427.43 | 1 |
| CT | $442.38 | 1 |
| DC | $471.63 | 1 |
| DE | $408.66 | 1 |
| FL | $414.04–$462.36 | 3 |
| GA | $388.90–$423.47 | 2 |
| GU | $441.14 | 1 |
| HI | $441.14 | 1 |
| IA | $375.83 | 1 |
| ID | $379.05 | 1 |
| IL | $403.71–$447.59 | 4 |
| IN | $381.29 | 1 |
| KS | $375.42 | 1 |
| KY | $381.33 | 1 |
| LA | $381.28–$400.97 | 2 |
| MA | $425.26–$469.08 | 2 |
| MD | $416.28–$471.63 | 3 |
| ME | $382.68–$402.37 | 2 |
| MI | $393.13–$420.97 | 2 |
| MN | $404.62 | 1 |
| MO | $375.36–$400.72 | 3 |
| MS | $369.36 | 1 |
| MT | $413.79 | 1 |
| NC | $386.66 | 1 |
| ND | $399.35 | 1 |
| NE | $377.56 | 1 |
| NH | $422.03 | 1 |
| NJ | $446.04–$466.63 | 2 |
| NM | $395.98 | 1 |
| NV | $410.04 | 1 |
| NY | $392.88–$493.94 | 5 |
| OH | $390.17 | 1 |
| OK | $379.06 | 1 |
| OR | $405.50–$439.88 | 2 |
| PA | $390.01–$431.86 | 2 |
| PR | $416.49 | 1 |
| RI | $422.44 | 1 |
| SC | $389.34 | 1 |
| SD | $397.65 | 1 |
| TN | $377.59 | 1 |
| TX | $387.43–$427.19 | 8 |
| UT | $394.90 | 1 |
| VA | $402.01–$471.63 | 2 |
| VI | $416.49 | 1 |
| VT | $399.05 | 1 |
| WA | $424.04–$477.39 | 2 |
| WI | $385.45 | 1 |
| WV | $388.42 | 1 |
| WY | $407.50 | 1 |
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
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.
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
| 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) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| 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 · 28435
Talus fracture care
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
28435 without 50 · national office
$413.84
Talus fracture care
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).
28435 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 28430Talus fracture care
- Choose 28430 for closed talus fracture treatment without manipulation. Choose 28435 when the clinician actively manipulates the fracture to improve alignment.
- 28436Talus fracture fixation
- 28436 is for talus fracture treatment with percutaneous skeletal fixation. 28435 describes closed manipulation without that fixation.
- 28445Talus fracture surgery
- 28445 applies when the talus fracture is treated with open reduction and internal fixation; 28435 is for closed manipulation.
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
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