Summary & Overview
CPT 28465: ORIF of Displaced Tarsal Bone Fracture with Screw Fixation
CPT code 28465 represents an open reduction and internal fixation (ORIF) procedure for displaced tarsal bone fractures using screw fixation, excluding procedures on the talus and calcaneus. This surgical code is used to bill operative repair of midfoot and other tarsal fractures where screws are affixed to stabilize the bone. Nationally, accurate use of this code matters for appropriate surgical reporting, resource allocation, and postoperative quality tracking.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides clinicians, coders, and policy analysts with benchmarks on utilization, payer policies that commonly affect coverage and prior authorization, and the clinical context that distinguishes 28465 from other foot and ankle fracture codes.
Readers will learn the clinical scenario appropriate for 28465, typical sites of service and providers who perform the procedure, and where billing disputes commonly arise. The report also summarizes common modifiers used with surgical procedures when available and notes areas where payers often require documentation (for example, fracture displacement, fixation method, and exclusion of talus or calcaneus). Data not available in the input is identified explicitly where relevant.
Billing Code Overview
CPT code 28465 describes an open reduction and internal fixation (ORIF) of a displaced tarsal bone fracture with fixation by affixing screws. The procedure explicitly excludes work on the talus and calcaneus.
Service type: Surgical — Orthopedic operative procedure (open reduction with internal fixation)
Typical site of service: Hospital operating room or ambulatory surgical center, performed by an orthopedic or podiatric surgeon with operating-room-level anesthesia and sterile operative setup.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 28-year-old male who presents to the emergency department after an acute inversion injury to the midfoot sustained while playing soccer. Imaging (plain radiographs and CT scan) demonstrates a displaced fracture of a tarsal bone (for example a cuboid or navicular) without talus or calcaneus involvement. The orthopedic foot and ankle surgeon evaluates the patient, documents neurovascular status and soft-tissue condition, and schedules operative management. In the operating room under general or regional anesthesia, the surgeon performs an open reduction of the displaced tarsal fracture and applies internal fixation using screws (and if needed small plates) to restore alignment and stability consistent with CPT 28465. Postoperative workflow includes routine intraoperative imaging to confirm reduction, application of a sterile dressing and splint or short leg cast, postoperative pain management, and instructions for non–weight-bearing immobilization. Follow-up visits include wound checks, radiographic surveillance for fracture healing, and staged progression to protected weight bearing and rehabilitation as tolerated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT / RT | Left / Right procedural modifier | Use to specify which foot was operated on when laterality is required by payer or for claims adjudication. |