Summary & Overview
CPT 28405: Closed Treatment of Calcaneal Fracture
CPT code 28405 denotes closed treatment of a calcaneal fracture, a non‑open realignment procedure for the heel bone. This code captures a subset of orthopedic fracture care that avoids skin incision and is important for tracking use of non‑operative or closed reduction techniques nationally. Its placement in billing and claims workflows affects facility and professional reimbursement, utilization monitoring, and quality measurement for musculoskeletal trauma care.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for this service, typical settings where it is performed (hospital outpatient departments, ambulatory surgery centers, and emergency departments), and which stakeholders commonly manage and bill for the procedure. The publication outlines benchmark reporting elements, coding considerations relevant to closed fracture management, and policy or coverage themes that commonly affect access and payment for calcaneal fracture care.
This summary is intended for clinicians, coding professionals, payers, and policy analysts seeking a national perspective on how CPT code 28405 is used and classified within fracture treatment pathways. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 28405 describes closed treatment of a calcaneal fracture (a crack or break in the calcaneus, the heel bone) involving realignment of bone fragments without an incision of the skin. This procedure is a form of fracture management that restores heel anatomy through manipulative techniques rather than open surgical exposure.
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Service type: Closed fracture treatment (non‑open reduction)
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Typical site of service: Hospital outpatient department, ambulatory surgery center, or emergency department where orthopedic fracture reduction procedures are performed
Clinical & Coding Specifications
Clinical Context
A 42-year-old male presents to the emergency department after a fall from a ladder onto his heels. He reports acute heel pain, swelling, and inability to weight-bear on the affected side. Evaluation includes focused history, physical exam, and foot and ankle radiographs confirming a displaced intraarticular calcaneal fracture. The orthopedic trauma team performs closed reduction and percutaneous fixation or manipulation under procedural sedation without an open incision, consistent with a closed treatment of a calcaneal fracture. Typical workflow: initial emergency department stabilization and analgesia, imaging (plain radiographs; CT if complex), informed consent, procedural sedation in an operating room or procedure suite, closed reduction with manual or instrumented manipulation, possible percutaneous pin or screw placement under fluoroscopic guidance, post-procedure immobilization in a splint or cast, and post-procedure outpatient follow-up with repeat imaging and rehabilitation planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, or difficulty substantially exceed typical for 28405 and documentation supports additional work. |
23 |