CPT code 28415 – Open calcaneal fracture repair with internal fixation

Key takeaways

CPT code 28415 reports open treatment of a calcaneal fracture, including any internal fixation, and switches to 28420 when autogenous bone graft is harvested.

Pair it with an S92.01- code for a body fracture or an S92.06- code for an intraarticular fracture, with the right side and seventh character.

The 90-day global period runs from the day before surgery to 90 days after it, so routine post-op visits aren’t billed separately.

Medicare’s 2026 values put 28415 at about 16 work RVUs and about 32 total facility RVUs.

Pabau sends US claims through Claim.MD to thousands of payers, with real-time eligibility checks, ERA remittances and secondary claims.

CPT code 28415 covers open calcaneal fracture repair, fixation included

CPT code 28415 reports open treatment of a calcaneal fracture, and any internal fixation the surgeon places is part of the code.

The descriptor reads “Open treatment of calcaneal fracture, includes internal fixation, when performed,” as quoted in AAPC’s Podiatry Coding & Billing Alert. The American Medical Association owns that wording.

A harvested autograft changes the code. CPT 28420 is the separate code for open treatment “with primary iliac or other autogenous bone graft, includes internal fixation, when performed.” The graft language in the operative note decides between the two.

The calcaneal fracture series runs from closed care to open repair with graft. Confirm where the case sits before you pick a code. A fracture of another tarsal bone, such as the cuboid or navicular, treated closed without manipulation codes to 28450 instead.

Two questions in the operative note settle the choice, and the diagram walks through them in order.

Autogenous bone graft is the line between 28415 and 28420

The one coding decision between 28415 and 28420 is whether autogenous bone graft was harvested and placed in the same session.

CPT code 28415 applies when the surgeon performs open reduction and internal fixation without a graft from the iliac crest or another donor site. CPT 28420 applies when autogenous graft fills a void or supports the fixation.

Synthetic or allograft bone substitute does not trigger 28420. If the surgeon uses demineralized bone matrix or calcium phosphate filler and harvests nothing, CPT code 28415 stays correct. For a 28420 claim to survive an audit, the operative report must name the graft source.

A malunion treated later with a calcaneal osteotomy is a different procedure. It codes to 28300, not to either fracture code.

Open treatment needs imaging that justifies it

Payers expect medical necessity on file before they approve CPT code 28415. Closed treatment codes (28400 and 28405) fit a fracture with minimal displacement that responds to conservative care.

Open treatment becomes the documented choice when displacement, articular step-off or a collapsed Böhler’s angle passes the threshold in the operative indication. That is often an articular step-off over 2 mm or marked comminution, though payer policies vary.

The operative report and the pre-operative CT together form the medical necessity record. Commercial payers routinely deny prior authorization requests for 28415 that arrive without CT imaging, and many Medicare Advantage plans apply the same standard.

Pair 28415 with an S92.01- or S92.06- ICD-10 code

A CPT 28415 claim needs an ICD-10-CM code from S92.0-, fracture of calcaneus. Use S92.01- for a fracture of the body of the calcaneus and S92.06- for an intraarticular fracture.

Other parts of the bone have their own subcategories. S92.02- covers the anterior process, S92.03- an avulsion fracture of the tuberosity, S92.04- other tuberosity fractures and S92.05- other extraarticular fractures.

In S92.01-, the sixth character carries displacement and side together. S92.011, S92.012 and S92.013 are displaced fractures of the right, left and unspecified heel. S92.014, S92.015 and S92.016 are the nondisplaced versions.

Leave the unspecified side for cases where the record truly doesn’t say. A displaced extraarticular fracture with no side documented codes to S92.053A, and payers often query that missing laterality.

Episode-of-care reminder: the seventh character “A” belongs on the surgery date. Post-op visits in the global period use “D” for routine healing or “G” for delayed healing. A wrong seventh character on a follow-up visit trips an edit against the date-of-service pattern already on file.

How a 28415 claim moves from the OR to payment

A calcaneal ORIF claim passes through six hands before it is paid. Here is the route, step by step.

1. Before surgery. The front desk checks eligibility and confirms the prior authorization covers 28415, the operated side and the date.
2. In the OR. The surgeon records the approach, the reduction, the implants and whether any graft was harvested.
3. Charge capture. The coder picks 28415 or 28420, adds RT or LT, and links an S92.01- or S92.06- code ending in A.
4. Scrubbing. Same-day lines for splints, imaging or external fixators are checked against the current NCCI edits.
5. Submission. The claim goes out electronically as an 837P, and the payer answers with an ERA.
6. Follow-up. Post-op visits inside the global period are logged with 99024 at no charge, and the diagnosis moves to seventh character D or G.

Most rework starts at step three. The next sections cover what the claim is worth, what the global period bundles and which edits decide whether step four passes.

Medicare values 28415 at about 32 facility RVUs

CPT code 28415 is a major surgical code. The CMS 2026 fee schedule file, viewed through the FastRVU lookup tool, puts its work RVU at about 16. Total facility RVUs come to about 32, and non-facility totals to about 34.

Values change every year with the CMS final rule. Check the current CMS Physician Fee Schedule before you quote expected payment.

Geographic locality changes the dollar amount a practice receives. Medicare payment is Total RVU x Geographic Adjustment Factor (GAF) x Conversion Factor. For a locality-specific rate, search the CMS fee schedule and filter by your MAC jurisdiction.

The 90-day global period starts the day before surgery

CPT code 28415 carries a 90-day global surgical period, confirmed by CMS with a 090 global indicator. The Medicare global package covers the day before surgery, the day of surgery and the 90 days after it.

Routine post-op care in that window is bundled into the surgical fee. Medicare and most commercial payers won’t pay it separately.

Bundled (cannot be billed separately):

• Post-operative office visits related to the fracture repair (E/M services)
• Dressing changes and wound checks by the surgeon
• Suture and staple removal
• Cast or splint applications that are part of routine post-op care
• X-ray interpretation ordered as part of normal post-op monitoring

Billable with a modifier during the global period:

• Treatment of a new, unrelated condition (modifier -79)
• A staged or related procedure planned at the time of the original surgery (modifier -58)
• An unplanned return to the operating room for a complication (modifier -78)
• -57: E/M that resulted in the decision for surgery

RT or LT belongs on every 28415 line

The right modifier keeps a CPT code 28415 claim out of automatic denial. The table lists the modifiers that matter for calcaneal ORIF, when each applies and the documentation behind it.

NCCI edits fold the splint into the surgery

The AAPC Codify reference and the CMS NCCI edit tables show which codes bundle with CPT code 28415 on the same claim. NCCI edits update quarterly, so check the current edit status before you submit a multi-line claim.

CPT 29515 (application of short leg splint, static) is the code that bundles most often. A splint applied at the close of a calcaneal ORIF is part of the surgery and isn’t billed separately. Modifier -59 does not override this edit, because the splint is integral to the procedure.

A clean 28415 claim starts with the operative note

A complete operative report is the base of a clean claim for CPT code 28415. Payers audit calcaneal ORIF records closely because the code carries high RVUs. The note should cover each element below.

• Pre-operative diagnosis: fracture type, side, displacement and Böhler’s angle or articular step-off, recorded in the admission or pre-op note
• Surgical approach: extensile lateral or sinus tarsi approach, incision length and soft-tissue handling
• Fracture visualization and reduction: the fracture pattern on direct inspection and the reduction technique
• Fixation method and implants: plate type, screw count, screw lengths and implant manufacturer
• Wound closure: layered closure, plus any drain placed
• Post-operative plan: weight-bearing limits, splint type and follow-up interval

The superbill for the encounter should carry CPT 28415, the matching ICD-10 code and the laterality modifier. Add the anesthesia provider before the claim leaves the practice.

Before you submit: Run this six-point check

Run this list against every 28415 claim at charge capture. Each item maps to a denial in the table further down.

• The prior authorization number matches 28415, the side and the date of service.
• The operative note states the approach and the graft source.
• RT or LT sits on the 28415 line.
• The ICD-10 code names the right part of the calcaneus and the right side, with seventh character A.
• No same-day 29515 splint line sits beside 28415.
• Any -22 claim carries the note that documents the extra work.

Six denial patterns to catch before they cost you

Calcaneal ORIF claims tend to fail on a short list of avoidable errors. The table maps each denial reason to its root cause and a prevention step.

High-volume foot and ankle practices feel these denials most. Structured denial management and a tracker of common denial codes cut the rework that slows collections.

How Pabau keeps 28415 claims moving to payment

In many practices, the steps above run through separate tools. The authorization sits in an email, the op note in the EHR and the claim in a clearinghouse portal.

Pabau, the practice management platform we build, runs US insurance billing through Claim.MD. Its claims management software sends 837P claims electronically to thousands of US payers. It also handles real-time eligibility checks (270/271), ERA remittances and secondary claims.

Prior authorization is tracked on the patient’s case, with the auth code, dates and sessions recorded. Pabau warns staff when an auth is missing, so a calcaneal ORIF doesn’t reach the schedule without one.

Submit 28415 claims with eligibility already checked

Pabau sends CPT 28415 claims electronically through Claim.MD to thousands of US payers. Real-time eligibility checks, ERA remittances and secondary claims run from the same patient record.

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Conclusion

CPT code 28415 rewards coders who read the operative note before the code book. The approach and the graft source settle the CPT code. The side, the fracture part and the episode settle the ICD-10 code.

If you change one habit, move the six-point check into charge capture instead of denial follow-up. A claim fixed before submission takes minutes, while a resubmitted one holds up payment for weeks.

Book a demo to see how Pabau checks eligibility and sends calcaneal fracture claims through Claim.MD from one patient record.

Continue your research

Need to understand how clearinghouse billing works for surgical codes? Medical claims clearinghouse guide explains how payer connections, claim scrubbing, and ERA processing reduce surgical code denials.

Looking to understand the full revenue cycle for orthopedic practices? Revenue cycle management guide covers the end-to-end billing workflow from eligibility to payment posting.

Need a reference for electronic claim formats and 837P submission? 837P file guide explains HIPAA transaction standards, claim segments, and how surgical claims are structured for payer submission.

Coding the follow-up visits after a calcaneal ORIF? Calcaneus fracture coding guide walks through seventh characters for delayed healing on a tuberosity fracture.

Treating a calcaneal malunion instead? CPT code 28300 covers calcaneal osteotomy billing and reimbursement.

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