CPT Code 28450: Overview

Quick Answers Box

What does CPT code 28450 cover?
CPT 28450 is the code for treatment of a tarsal bone fracture (except the talus and calcaneus) without manipulation, billed per bone treated. It is non-operative fracture care: the provider stabilizes a fracture that is already in acceptable alignment, with no reduction. If the bone has to be manipulated back into position, the correct code is 28455, not 28450.

Can you bill the cast separately with 28450?
Not for the initial cast. When 28450 is billed as restorative fracture care, the first cast or splint application is part of the global service, so you do not separately report a cast application code like 29405 on that date. You can report the casting supplies with the appropriate HCPCS Q-codes, and a replacement cast later in the global period is billable with modifier 58.

Does CPT 28450 have a global period?
Yes, 28450 carries a 90-day global period. The single fee covers the restorative treatment plus routine follow-up visits across that window, so normal cast checks inside the 90 days are not separately billable. Billing those routine visits on their own is one of the most common denial triggers on this code.

What CPT Code 28450 Actually Says

The official AMA descriptor is precise, and the precision is the point:

28450, Treatment of tarsal bone fracture (except talus and calcaneus); without manipulation, each.

Three elements do the heavy lifting:

• Tarsal bone fracture. The injury is in the rearfoot or midfoot, not the metatarsals and not the toes.
• Except talus and calcaneus. Those two bones have their own dedicated code families and are explicitly carved out of 28450.
• Without manipulation, each. No reduction was performed, and the code is billed per tarsal bone treated.

Older summaries that describe 28450 as a code that “includes a walking or ambulation cast” are inaccurate. The cast is handled by a separate set of rules covered further down. Coding this from the cast instead of from the fracture care is one of the fastest ways to land in a denial or an audit.

The Seven Tarsal Bones, and the Two That Do Not Belong Here

The foot has seven tarsal bones: the talus, calcaneus, navicular, cuboid, and the medial, intermediate, and lateral cuneiforms. CPT 28450 applies to five of them. The talus and calcaneus are excluded because they carry dedicated codes:

• Talus fractures are reported with the 28430 to 28445 family.
• Calcaneus fractures are reported with the 28400 to 28420 family.

So a navicular, cuboid, or cuneiform fracture treated without reduction is the textbook 28450 scenario. A talus or calcaneus fracture is never 28450, even when the treatment approach looks identical. This is also why the navicular question comes up so often in coding forums: it is a tarsal bone, it is not excluded, and it does belong to 28450 when treated without manipulation.

28450 vs. 28455, 28456, and 28465

Tarsal fracture treatment is a four-code ladder, and the documentation decides the rung:

• 28450, treatment without manipulation, each. Closed care, no reduction.
• 28455, treatment with manipulation, each. Closed care, the provider reduces the fracture.
• 28456, percutaneous skeletal fixation, with manipulation, each. Pins or wires placed through the skin.
• 28465, open treatment, includes internal fixation when performed, each. The fracture is surgically exposed and fixed.

Reading the operative or treatment note for the words “manipulation,” “reduction,” “percutaneous,” or “open” before you assign the code prevents the most common upcode and downcode errors on this family. The “each” unit also matters: if two separate tarsal bones are treated, the code is reported per bone, with anatomic modifiers where the payer requires them.

The 90-Day Global Period and What It Bundles

28450 is fracture care, which means it carries a 90-day global period. The single fee is not just for the day of service. It covers the restorative treatment plus the routine follow-up visits across that 90-day window. Billers who try to add an office visit for a normal cast check inside the global period are the ones who generate the duplicate-service denials.

Two practical consequences follow:

• Routine follow-up during the 90 days is included and not separately billable.
• An evaluation and management service on the same date as the decision to provide fracture care can be separate, but only with the correct modifier (covered next).

Billing the Cast: Where 28450 and 29405 Get Confused

Here is the question that derails more 28450 claims than any other: can I bill for the cast separately?

When 28450 is reported as restorative fracture care, the initial cast or splint application is part of that global service. You do not separately report a cast application code such as the short leg walking cast under CPT 29405 for that first cast on the same date you assume fracture care. What you can report separately are the casting supplies, using the appropriate HCPCS Level II Q-codes, and the payer decides whether those supplies are paid.

The cast application code comes back into play in two specific situations:

• A replacement cast applied during the 90-day global period. Report the cast application code with modifier 58 (staged or related procedure during the postoperative period).
• A provider who only applies the cast and does not assume restorative fracture care. In that case you bill the cast application code plus an E/M service, not 28450.

In short: 28450 is the fracture care package, not the cast code. Treating it as a “cast code” is the root of the denials, and it is the exact error in the descriptions floating around the rest of the web.

Modifiers That Protect the 28450 Claim

Two modifiers do most of the work on this code:

• Modifier 57, decision for surgery. Append it to the E/M on the day the provider decides to render fracture care, so the visit is not bundled into the global service.
• Modifier 58, staged or related procedure during the postoperative period. Use it for a planned recast or related procedure inside the 90 days.

Anatomic modifiers (such as the toe and foot site modifiers, or LT and RT where the payer accepts them) support the “each” billing unit when more than one bone or site is involved.

Pairing 28450 With the Right ICD-10 Code

The number one denial reason on procedure codes is a CPT and ICD-10 mismatch. 28450 has to be paired with a tarsal fracture diagnosis, which lives in the S92.2 family (fracture of the tarsal bones), with the correct seventh character for the encounter. Use the active-treatment seventh character (A) on the initial encounter, not a healing or sequela character, or the claim contradicts itself: a fracture care code attached to an aftercare diagnosis is an automatic denial. Match the laterality and the specific bone where the documentation supports it. For a fast reference across your most-billed foot codes, keep the podiatry billing and coding cheat sheet handy at intake.

Reimbursement Reality

28450 is valued as a non-operative service, so the payment is modest relative to surgical tarsal repair. Medicare has historically valued the code at roughly 5.5 RVUs, and actual payment varies by payer, locality, and year. Because the fee is a global package rather than a per-visit charge, the revenue protection is less about the rate and more about coding it cleanly the first time: correct manipulation status, correct global handling, correct ICD pairing, and correct cast treatment. A single avoidable denial on this code often costs more in rework than the claim is worth.

Common 28450 Billing Mistakes

• Using 28450 for a talus or calcaneus fracture. Both are excluded and carry their own codes.
• Using 28450 when the fracture was manipulated. That is 28455.
• Reporting a cast application code for the initial cast on the same date as fracture care.
• Billing routine follow-up visits separately inside the 90-day global period.
• Pairing 28450 with an aftercare or healing diagnosis instead of an active-treatment fracture code.
• Forgetting the “each” unit when two separate tarsal bones are treated.

Frequently Asked Questions