$245.23–$255.67
Use 28455 when the tarsal fracture is treated closed with manipulation. Use 28465 when treatment involves open surgical exposure and reduction.
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CMS RVU26D · Effective 2026-10-01
28465 Tarsal fracture repair Medicare reimbursement rates in Maine
Report open surgical treatment for each fractured tarsal bone other than the talus or calcaneus when the fracture is exposed and reduced. Compare 28465 office and facility rates across CMS payment localities in Maine.
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 28465 in Maine?
Maine has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$579.41–$600.24
2 of 2 localities have a supported rate.
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 28465: Open treatment of other tarsal fracture
Report open surgical treatment for each fractured tarsal bone other than the talus or calcaneus when the fracture is exposed and reduced.
An orthopedic foot-and-ankle surgeon uses this code when surgically exposing and reducing a fracture of a tarsal bone other than the talus or calcaneus. Examples of included bones are the navicular, cuboid, and cuneiforms. Internal fixation may be used as part of the repair. These procedures are commonly performed in an operating room for fractures requiring open correction rather than closed treatment or percutaneous fixation.
Report the service for each treated bone and document the bone involved, fracture, open surgical approach, and reduction performed. Choose a closed-treatment or percutaneous-fixation code when that is the method used. The 90-day global period 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%. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.
CMS billing rules for 28465
- 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 RVU8.58 · 46%
- Practice expense (office) RVU8.61 · 46%
- Malpractice RVU1.36 · 7%
330
Medicare services in 2024 · #3919 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.
28465 compared with similar codes
Office rates for Maine, from the same CMS release.
No office rate
Code 28456 is for percutaneous skeletal fixation with manipulation; 28465 represents open treatment of the fracture.
No office rate
Code 28445 is for open treatment of a talus fracture. Code 28465 applies to other tarsal bones, not the talus or calcaneus.
Compare 28465 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.
2 of 2 payment localities
Rest Of Maine →
Office / nonfacility
Unavailable
Facility
$579.41
Southern Maine →
Office / nonfacility
Unavailable
Facility
$600.24
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28465 billing questions
Which tarsal bones are included?
This code covers open treatment of tarsal bones other than the talus and calcaneus, such as the navicular, cuboid, or cuneiforms. Talus and calcaneus fractures have their own codes.
How does this differ from 28455?
Use 28465 for open treatment. Code 28455 describes closed treatment with manipulation, without open surgical treatment.
Is internal fixation included?
Yes. Internal fixation may be part of the open fracture treatment represented by this code; do not separately report a percutaneous fixation service for the same fracture.
How should units be reported for multiple bones?
The code is reported for each treated tarsal bone. Document the specific bone treated; do not use the code for a talus or calcaneus fracture.
Can modifier 50 be used for bilateral treatment?
No. CMS identifies bilateral adjustment as inappropriate for this code. The descriptor is reported per bone.
Can an assistant or co-surgeon be billed?
Medicare does not pay an assistant at surgery for this code. 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.
3,20828450,,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
3,21428476,,Prq skel fix metar fx w/mnpj,A,,3.51,7.55,NA,7.55,,0.55,11.61,11.61,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00