Summary & Overview
CPT 28400: Closed Treatment of Calcaneal (Heel) Fracture
CPT code 28400 represents the closed treatment of a calcaneal (heel bone) fracture without manipulation or open surgery. This code captures nonoperative orthopedic management of heel fractures—an important category of musculoskeletal care that affects trauma, emergency, and orthopedic practice nationally. Proper coding of closed calcaneal fracture treatment influences claims processing, site-of-service classification, and aggregate utilization measures across payers.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for closed calcaneal fracture management, expected sites of care, and typical service characterization. The publication covers benchmark considerations, common modifier usage where applicable, and policy and coverage factors that affect reimbursement and authorization for nonoperative fracture treatment. It contextualizes CPT code 28400 within orthopedic service lines and highlights issues relevant to hospital, ambulatory surgery, and emergency settings.
This national-level summary is intended for coding professionals, revenue cycle staff, and policy analysts seeking a concise reference on what CPT code 28400 denotes, why it matters in clinical and billing workflows, and what policy and payer factors commonly affect its adjudication.
Billing Code Overview
CPT code 28400 describes a closed treatment of a calcaneal fracture (fracture of the calcaneus, or heel bone) without manipulation and without open surgical incision. The procedure involves noninvasive stabilization and care directed at aligning and immobilizing the fractured calcaneus using closed techniques.
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Service type: Fracture treatment (closed), orthopedic injury management
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Typical site of service: Hospital inpatient or outpatient orthopedic department, emergency department, or ambulatory surgery/orthopedic clinic depending on clinical severity and resources available
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 42-year-old male construction worker presents to the emergency department after a fall from a ladder onto his heels. He has acute heel pain, swelling, and inability to bear weight on the affected foot. Radiographs (and often CT for complex patterns) confirm a nondisplaced or minimally displaced calcaneal (heel bone) fracture without soft-tissue compromise. The orthopedic provider assesses neurovascular status and skin integrity, documents mechanism of injury and informed consent, and determines that closed, nonoperative management is appropriate.
The clinical workflow includes initial ED evaluation, imaging, analgesia and immobilization (splint or cast), and scheduling of closed treatment in the operating room or procedure suite if manipulation under anesthesia is required. The closed treatment involves reduction maneuvers without open incision and may include application of a cast, splint, or closed fixation techniques that do not breach the skin. Postprocedure documentation includes pre- and post-reduction neurovascular checks, anesthesia type, description of the reduction or immobilization performed, and follow-up instructions for weight-bearing and repeat imaging.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure | Use when an E/M visit is performed on the same day as that is distinct from the procedural care (e.g., initial ED evaluation and decision-making documented separately). |