Summary & Overview
CPT 28406: Open Reduction, Internal Fixation of Calcaneal Fracture
CPT code 28406 denotes open reduction and internal fixation of a calcaneal (heel) fracture, a procedure that repositions and secures the largest tarsal bone using hardware such as pins and wires. This code matters nationally because calcaneal fractures often require specialized orthopedic surgical care, can result from high-energy trauma, and carry implications for hospital resource use, surgical scheduling, and postoperative rehabilitation. Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for CPT code 28406, typical sites of service, and the procedural scope. The publication outlines payer coverage considerations, common billing modifiers associated with surgical services, and areas where coding clarity affects claims processing and reimbursement. It also summarizes expected clinical pathways following fixation, potential impacts on hospital and ambulatory surgical center workflows, and where stakeholders commonly encounter authorization or documentation questions. Data not available in the input is noted where detail is missing.
Billing Code Overview
CPT code 28406 describes open treatment of a calcaneal (heel) fracture using internal fixation. The procedure involves manipulation of the fractured calcaneus and stabilization with hardware such as pins and wires to restore bone alignment and heel structure.
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Service type: Surgical orthopedic procedure — open reduction and internal fixation of a calcaneal fracture
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Typical site of service: Hospital inpatient or ambulatory surgical center, depending on fracture severity and patient factors
Clinical & Coding Specifications
Clinical Context
A typical patient is a 35–55 year-old male who presents to the emergency department after a fall from height or motor vehicle collision with acute heel pain, swelling, and inability to bear weight. Initial evaluation includes history, focused musculoskeletal and neurovascular exam, and plain radiographs (AP, lateral, and Bohler’s view) confirming a displaced calcaneal fracture. The orthopedic trauma team performs preoperative planning, obtains informed consent, and arranges operative fixation. In the operating room under regional or general anesthesia, the surgeon performs open reduction and internal fixation (ORIF) of the calcaneus using plates, screws, pins, or wires to restore articular congruity and heel height. Postoperative workflow includes pain control, neurovascular checks, dressing and splint application, radiographic confirmation of hardware position, non–weight-bearing instructions, and scheduled outpatient follow-up with serial radiographs and physical therapy initiation when healing permits. Hospital admission may be required for pain control, monitoring for compartment syndrome, or medical comorbidity management; many straightforward cases are done as same-day surgery in an ambulatory surgery center when clinically appropriate.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the surgeon’s professional service separate from technical facility charges for imaging or procedures that separate components. |