$238.18
Choose 28456 when manipulation is accompanied by percutaneous skeletal fixation. Code 28455 describes tarsal fracture treatment with manipulation without that fixation.
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CMS RVU26D · Effective 2026-10-01
28456 Tarsal fracture fixation Medicare reimbursement rates in Alabama
Reports percutaneous skeletal fixation with manipulation of a tarsal bone fracture other than the talus or calcaneus, counted for each bone treated. Compare 28456 office and facility rates across CMS payment localities in Alabama.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 28456 in Alabama?
Alabama has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$341.07
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Orthopedic surgery
About 28456: Percutaneous tarsal fracture fixation with manipulation
Reports percutaneous skeletal fixation with manipulation of a tarsal bone fracture other than the talus or calcaneus, counted for each bone treated.
This procedure treats a fracture of a tarsal bone other than the talus or calcaneus. The surgeon manipulates the fracture to improve alignment and stabilizes it with skeletal fixation placed percutaneously, without open exposure of the fracture. Orthopedic and foot-and-ankle surgeons typically perform it in an operating room when closed manipulation alone is not sufficient and fixation is needed.
Report the code for each qualifying tarsal bone treated. The operative report should identify the bone, document manipulation and percutaneous skeletal fixation, and support the number of bones billed. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed 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. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 28456
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.79 · 24%
- Practice expense (office) RVU8.10 · 71%
- Malpractice RVU0.59 · 5%
43
Medicare services in 2024 · #5446 by national volume
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.
28456 compared with similar codes
Office rates for Alabama, from the same CMS release.
No office rate
Code 28465 describes open treatment of a qualifying tarsal bone fracture. Code 28456 is for percutaneous skeletal fixation with manipulation.
No office rate
Code 28436 is the percutaneous fixation option for a talus fracture with manipulation. Code 28456 is for other tarsal bones, excluding the talus and calcaneus.
Compare 28456 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Alabama →
Office / nonfacility
Unavailable
Facility
$341.07
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 28456 in Alabama.
PPRRVU2026_Oct_nonQPP.csv
3,210
- Code
- 28456
- Physician work
- 2.79
- Practice expense
- 8.10
- Malpractice
- 0.59
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.79 | × 1.000 | 2.7900 |
| Practice expense | 8.10 | × 0.875 | 7.0875 |
| Malpractice | 0.59 | × 0.566 | 0.3339 |
| Total RVUs | 10.2114 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Alabama$341.07
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.79 | 1 |
| Practice expense | 8.1 | 0.875 |
| Malpractice | 0.59 | 0.566 |
(2.79 × 1 + 8.1 × 0.875 + 0.59 × 0.566) × $33.4009 = $341.07
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
28456 billing questions
How does this differ from 28455?
Code 28456 includes percutaneous skeletal fixation as well as manipulation. Code 28455 is for manipulation without the percutaneous skeletal fixation described by 28456.
Which tarsal bones are included?
The code covers tarsal bones other than the talus and calcaneus. Those two bones have separate fracture-treatment codes.
How should units be counted?
The descriptor specifies each bone treated. Document the individual qualifying tarsal bone or bones that received manipulation and percutaneous fixation.
Can modifier 50 be used for bilateral treatment?
No. CMS identifies bilateral adjustment as inappropriate for this code. Report the service based on each qualifying bone treated.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be billed?
Medicare does not pay an assistant at surgery for this procedure, and co-surgeons and team surgery are not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
3,20728446,,Opn osteochondrl agrft talus,A,,17.27,12.76,NA,12.76,,3.67,33.70,33.70,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,20828450,,Tx tarsal b1 fx w/o mnpj ea,A,,1.98,4.67,,3.56,,0.28,6.93,5.82,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,20928455,,Tx tarsal b1 fx w/mnpj each,A,,3.16,4.37,,3.20,,0.26,7.79,6.62,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,21028456,,Prq skel fix tarsl fx w/mnpj,A,,2.79,8.10,NA,8.10,,0.59,11.48,11.48,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,21128465,,Optx tarsal bone fx each,A,,8.58,8.61,NA,8.61,,1.36,18.55,18.55,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,21228470,,Cltx metatarsal fx wo mnp ea,A,,1.98,4.83,,3.98,,0.29,7.10,6.25,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,21328475,,Cltx metatarsal fx w/mnpj ea,A,,2.93,4.94,,3.40,,0.39,8.26,6.72,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1ADDENDUM E. FINAL CY 2026 GEOGRAPHIC PRACTICE COST INDICES (GPCIs) BY STATE AND MEDICARE LOCALITY,,,,,,
2,,,,,,
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515