Billing code 28476: Metatarsal fractureMedicare rate & RVUs in Guam
Reports manipulation and percutaneous skeletal fixation of a metatarsal fracture when reduction and pin or wire stabilization are performed without open exposure.
CMS doesn’t publish an office rate for 28476 in Guam.
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 9 sections
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.
28476 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $414.60 |
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
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
| 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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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 · 28476
Metatarsal fracture
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 51 · payment effect
With and without the modifier
28476 without 51 · national facility
$387.78
Metatarsal fracture
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%).
28476 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 28475Metatarsal fracture
- 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 care
- 28470 is for closed treatment without manipulation. 28476 includes manipulation and percutaneous skeletal fixation.
- 28485Metatarsal fracture surgery
- 28485 represents open treatment of a metatarsal fracture. 28476 is for manipulation and percutaneous fixation without open exposure.
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
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