Billing code 28406: Calcaneal fracture repairMedicare rate & RVUs in Washington
Reports manipulative reduction and percutaneous skeletal fixation of a calcaneal fracture when pins or screws stabilize the repositioned bone.
CMS doesn’t publish an office rate for 28406 in Washington.
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 28406 covers
An orthopedic trauma or foot-and-ankle surgeon uses manipulation to reposition a calcaneal fracture, then stabilizes it with skeletal fixation placed through the skin rather than through an open surgical exposure. The procedure is commonly performed in an operating room, often with imaging guidance, for a fracture requiring both reduction and percutaneous fixation. The service is specific to the calcaneus, the heel bone.
Report this code when the operative record supports both manipulation and percutaneous skeletal fixation; closed manipulation without fixation and open fixation are different services. Document the fracture site, laterality, reduction, and fixation performed. 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 others at 50%. Bilateral reporting with modifier 50 is paid at 150%. 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 28406 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $558.21 |
| Seattle (King Cnty) | Unavailable | $619.76 |
How the 28406 rate is calculated
Each of 28406’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 · 28406
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 6.40Practice expense 8.84Malpractice 1.21
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 28406
28406 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 28406
Calcaneal fracture repair
| 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| 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 · 28406
Calcaneal fracture repair
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 50 · payment effect
With and without the modifier
28406 without 50 · national facility
$549.44
Calcaneal fracture repair
28406-50 · Bilateral: 150%
$824.16
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
28406 compared with similar codes
Compare codes
28406 vs 28405 vs 28415 vs 28400 vs 28420: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 28405Heel fracture treatment
- Both involve manipulation of a calcaneal fracture, but 28406 includes percutaneous skeletal fixation; 28405 describes closed treatment without that fixation.
- 28415Heel fracture repair
- Use 28415 for open treatment of a calcaneal fracture. Use 28406 when reduction and skeletal fixation are performed percutaneously.
- 28400Fracture treatment
- 28400 is closed treatment of a calcaneal fracture without manipulation. 28406 includes manipulation and percutaneous skeletal fixation.
- 28420Calcaneal fracture repair
- 28420 describes open calcaneal fracture treatment with bone grafting; it is distinct from percutaneous fixation with manipulation.
28406 billing questions
How is 28406 different from closed treatment with manipulation?
Use 28406 when the calcaneal fracture is manipulated and percutaneous skeletal fixation is placed. Closed treatment with manipulation alone is represented by 28405.
When is open treatment a better code choice?
When the surgeon exposes the fracture for open fixation, consider 28415 rather than 28406. The operative approach and fixation described in the record distinguish the services.
What should the operative note support?
Document the calcaneal fracture, laterality, manipulative reduction, and percutaneous skeletal fixation. The note should make clear that fixation was placed through the skin rather than through open exposure.
How does the 90-day global period affect related care?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period for this major surgery.
Can 28406 be reported bilaterally?
For bilateral procedures, CMS applies modifier 50 and pays the procedure at 150%. Document treatment of both calcanei.
When is assistant-at-surgery payment allowed?
CMS allows assistant-at-surgery payment only when medical necessity is documented. Co-surgeons and team surgery are not permitted for this code.
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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