Summary & Overview
CPT 28455: Closed Treatment of Tarsal Bone Fracture
CPT code 28455 covers the closed treatment (manipulation) of tarsal bone fractures excluding the talus and calcaneus. It captures a common, non‑open approach to midfoot and rearfoot fractures that can be performed in emergency departments, ambulatory surgery centers, or inpatient settings. This code matters nationally as it affects billing for orthopedic, podiatric, and emergency services managing traumatic foot injuries and contributes to utilization and cost patterns for musculoskeletal trauma care.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, the typical sites of service, and the scope of services represented by the code. The publication also summarizes payer coverage considerations, common billing modifiers in use, and areas where coding clarity influences reimbursement and claims processing.
The report is intended to help billing managers, clinical coders, and policy analysts understand how CPT code 28455 is applied, where variations commonly occur, and what documentation elements support accurate coding. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 28455 describes the closed treatment of a tarsal bone fracture, except the talus and calcaneus. The procedure involves manipulation or adjustment of a fractured tarsal bone to restore alignment without an open surgical approach.
Service type: Closed fracture treatment / Manipulation of tarsal bones
Typical site of service: Hospital inpatient or outpatient settings, ambulatory surgery centers, or emergency departments where closed reductions of midfoot and rearfoot fractures are performed.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult who presents to the emergency department or orthopedic clinic after an acute inversion or crush injury to the foot. The patient reports localized midfoot or rearfoot pain, swelling, and reduced weight-bearing. Physical exam reveals focal bony tenderness over a tarsal bone (for example, navicular, cuboid, or cuneiform), possible deformity, and limited range of motion. Radiographs (AP, lateral, oblique) or CT confirm a non-displaced or minimally displaced fracture of a tarsal bone excluding the talus and calcaneus.
The clinical workflow includes triage and analgesia, imaging to confirm fracture location and alignment, and orthopedic evaluation. For closed treatment, the provider performs manipulation/adjustment of the fractured tarsal bone without open incision, typically in an emergency department procedure room, ambulatory surgery center, or outpatient clinic procedure room. Procedural steps include analgesia or conscious sedation as indicated, closed reduction maneuvers, post-reduction imaging to confirm alignment, immobilization with splinting or casting, and patient education on weight-bearing restrictions and follow-up. Typical settings are outpatient orthopedic clinics, emergency departments, and ambulatory surgery centers.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
RT / LT | Right or Left |