$254.85
Choose 28475 for closed treatment with manipulation but without percutaneous skeletal fixation. Use 28476 when pins or other percutaneous fixation are also performed.
On this page
CMS RVU26D · Effective 2026-10-01
28476 Metatarsal fracture Medicare reimbursement rates in Tennessee
Reports manipulation and percutaneous skeletal fixation of a metatarsal fracture when reduction and pin or wire stabilization are performed without open exposure. Compare 28476 office and facility rates across CMS payment localities in Tennessee.
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 28476 in Tennessee?
Tennessee 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
$356.33
1 of 1 localities have a supported rate.
Payment area: Tennessee
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 28476: Percutaneous metatarsal fracture fixation
Reports manipulation and percutaneous skeletal fixation of a metatarsal fracture when reduction and pin or wire stabilization are performed without open exposure.
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.
CMS billing rules for 28476
- 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
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU3.51 · 30%
- Practice expense (office) RVU7.55 · 65%
- Malpractice RVU0.55 · 5%
409
Medicare services in 2024 · #3721 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.
28476 compared with similar codes
Office rates for Tennessee, from the same CMS release.
$217.98
28470 is for closed treatment without manipulation. 28476 includes manipulation and percutaneous skeletal fixation.
No office rate
28485 represents open treatment of a metatarsal fracture. 28476 is for manipulation and percutaneous fixation without open exposure.
Compare 28476 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
Tennessee →
Office / nonfacility
Unavailable
Facility
$356.33
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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 28476 in Tennessee.
PPRRVU2026_Oct_nonQPP.csv
3,214
- Code
- 28476
- Physician work
- 3.51
- Practice expense
- 7.55
- Malpractice
- 0.55
GPCI2026.csv
95
- Locality
- Tennessee
- Physician work
- 1.000
- Practice expense
- 0.909
- Malpractice
- 0.537
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.51 | × 1.000 | 3.5100 |
| Practice expense | 7.55 | × 0.909 | 6.8629 |
| Malpractice | 0.55 | × 0.537 | 0.2954 |
| Total RVUs | 10.6683 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Tennessee$356.33
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.51 | 1 |
| Practice expense | 7.55 | 0.909 |
| Malpractice | 0.55 | 0.537 |
(3.51 × 1 + 7.55 × 0.909 + 0.55 × 0.537) × $33.4009 = $356.33
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.
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 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.
3,21128465,,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
3,21528485,,Optx metatarsal fx each,A,,7.25,7.96,NA,7.96,,1.02,16.23,16.23,0,090,0.10,0.69,0.21,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,21628490,,Treat big toe fracture,A,,1.14,3.44,,2.65,,0.17,4.75,3.96,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,21728495,,Treat big toe fracture,A,,1.64,4.02,,2.78,,0.20,5.86,4.62,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537
9604412,TX,31,AUSTIN,1.002,1.058,0.886
9704412,TX,20,BEAUMONT,1.000,0.910,0.929
9804412,TX,09,BRAZORIA,1.008,0.991,0.780