No office rate
28445 treats a talus fracture with open surgery. Choose 28446 for an osteochondral lesion treated with an autograft, not fracture fixation.
On this page
CMS RVU26D · Effective 2026-10-01
28446 Talar lesion surgery Medicare reimbursement rates in Vermont
Open surgery uses a bone-and-cartilage autograft to treat a focal osteochondral lesion of the talus, such as a symptomatic talar dome defect. Compare 28446 office and facility rates across CMS payment localities in Vermont.
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 28446 in Vermont?
Vermont 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
$1060.79
1 of 1 localities have a supported rate.
Payment area: Vermont
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 28446: Open talar osteochondral graft treatment
Open surgery uses a bone-and-cartilage autograft to treat a focal osteochondral lesion of the talus, such as a symptomatic talar dome defect.
The surgeon exposes the talus, addresses the osteochondral defect by drilling and removing loose fragments as indicated, and places an autograft to restore the damaged surface. This is typically performed by an orthopedic foot and ankle surgeon in a hospital or ambulatory surgical setting for a symptomatic talar lesion, including lesions that need graft reconstruction rather than fracture fixation or arthroscopic treatment alone. The graft harvest is included in the service.
Report the code when the operative record supports open treatment of a talar osteochondral lesion with autograft. Document the lesion, open approach, work performed, and graft use; do not select it for open fixation of a talus fracture. Medicare assigns a 90-day global period, including the day before surgery and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 applies to bilateral reporting, with payment at 150%. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 28446
- 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 procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU17.27 · 51%
- Practice expense (office) RVU12.76 · 38%
- Malpractice RVU3.67 · 11%
31
Medicare services in 2024 · #5638 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.
28446 compared with similar codes
Office rates for Vermont, from the same CMS release.
No office rate
29891 describes arthroscopic excision and drilling of an osteochondral defect; 28446 describes open treatment with autograft.
No office rate
29892 is for arthroscopic treatment of a talar osteochondritis dissecans lesion, with or without fixation. 28446 is the open autograft treatment.
Compare 28446 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
Vermont →
Office / nonfacility
Unavailable
Facility
$1060.79
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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 28446 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
3,207
- Code
- 28446
- Physician work
- 17.27
- Practice expense
- 12.76
- Malpractice
- 3.67
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 17.27 | × 1.000 | 17.2700 |
| Practice expense | 12.76 | × 0.990 | 12.6324 |
| Malpractice | 3.67 | × 0.506 | 1.8570 |
| Total RVUs | 31.7594 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$1060.79
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 17.27 | 1 |
| Practice expense | 12.76 | 0.99 |
| Malpractice | 3.67 | 0.506 |
(17.27 × 1 + 12.76 × 0.99 + 3.67 × 0.506) × $33.4009 = $1060.79
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.
28446 billing questions
How is this different from open treatment of a talus fracture?
This code is for open graft treatment of an osteochondral lesion. Use the talus-fracture code when the operation treats a fracture rather than a focal cartilage-and-bone defect.
When would an arthroscopic talar lesion code be considered instead?
Consider the arthroscopic code that matches the documented lesion treatment when the surgeon works arthroscopically. This code describes open treatment with autograft.
Is graft harvest separately reported?
No. Obtaining the autograft is included in this service.
What documentation supports reporting this code?
The operative report should establish the talar osteochondral lesion, the open approach, the treatment performed, and use of an autograft.
How are bilateral procedures handled?
CMS lists this as a bilateral procedure; modifier 50 is paid at 150%.
What applies when other procedures are performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation.
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.
3,20428435,,Cltx talus fracture w/mnpj,A,,3.45,8.21,,5.67,,0.73,12.39,9.85,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,20528436,,Prq skel fix talus fx w/mnpj,A,,4.78,9.07,NA,9.07,,1.03,14.88,14.88,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,20628445,,Optx talus fracture,A,,15.37,11.08,NA,11.08,,2.78,29.23,29.23,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,20728446,,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
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817