Billing code 28455: Tarsal fracture careMedicare rate & RVUs in Illinois
Report 28455 for closed treatment of a qualifying tarsal bone fracture when the clinician manipulates the fracture to restore alignment.
Medicare pays $252.38–$272.91 for 28455 in the office in Illinois, from Rest Of Illinois to Chicago. Which amount applies depends on the service address.
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 28455 covers
This code describes closed treatment of a tarsal bone fracture with manipulation to improve alignment, without open exposure or percutaneous skeletal fixation. Typical examples include manipulated fractures of the navicular, cuboid, or a cuneiform; calcaneus and talus fractures have separate codes. Orthopedic surgeons and podiatrists commonly provide this treatment in an office, emergency department, or hospital setting, followed by immobilization and fracture follow-up.
Report one unit for each tarsal bone treated, supported by documentation identifying the fracture site and the reduction or manipulation performed. Choose the code based on the bone and treatment method: manipulation distinguishes this service from closed treatment without manipulation, while fixation or open treatment points to other codes. CMS assigns a 90-day global period, including 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 other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. 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 28455 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$252.38 to $272.91
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $272.91 | $233.63 |
| East St. Louis | $257.32 | $221.37 |
| Rest Of Illinois | $252.38 | $216.70 |
| Suburban Chicago | $271.58 | $231.44 |
How the 28455 rate is calculated
Each of 28455’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 · 28455
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 3.16Practice expense 4.37Malpractice 0.26
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 28455
28455 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 28455
Tarsal 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) | 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 · 28455
Tarsal 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 51 · payment effect
With and without the modifier
28455 without 51 · national office
$260.19
Tarsal fracture care
28455-51 · Second procedure: 50%
$130.10
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%).
28455 compared with similar codes
Compare codes
28455 vs 28450 vs 28456 vs 28465 vs 28435: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 28450Tarsal fracture care
- Both address closed treatment of a tarsal bone fracture, but 28455 includes manipulation and 28450 is for treatment without manipulation.
- 28456Tarsal fracture fixation
- Choose 28456 when percutaneous skeletal fixation is used with manipulation. Choose 28455 for closed treatment with manipulation without that fixation.
- 28465Tarsal fracture repair
- 28465 describes open treatment of a tarsal bone fracture; 28455 is for closed treatment with manipulation.
- 28435Talus fracture care
- 28435 applies to a talus fracture treated closed with manipulation. Code 28455 is for other tarsal bones addressed by this code family.
28455 billing questions
How does 28455 differ from 28450?
Use 28455 when the tarsal fracture is manipulated to restore alignment. Code 28450 describes treatment without manipulation.
When would 28456 be more appropriate?
Use 28456 when the tarsal fracture is treated with percutaneous skeletal fixation and manipulation. Code 28455 describes closed treatment with manipulation without that fixation method.
Is the code reported once per fracture or once per bone?
The code is reported for each tarsal bone treated. Document the specific bone and the manipulation performed for each reported unit.
Can modifier 50 be used for fractures on both feet?
No. CMS identifies bilateral adjustment as inappropriate for this code; report the services according to the number of bones treated.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. Routine follow-up related to the fracture treatment falls within that period.
When is an assistant-at-surgery service payable?
CMS permits assistant-at-surgery payment only when medical necessity is documented. 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 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
Fee sheets
Put 28455 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →