CPT code 28470 – Closed metatarsal fracture treatment without manipulation

Key takeaways

CPT code 28470 covers closed treatment of a metatarsal fracture without manipulation, reported once per metatarsal treated.

Documentation decides the code: any note language describing reduction or realignment moves the claim to CPT 28475.

CPT 28470 carries a 90-day global surgical period, and casting at the same session is bundled into the payment.

The 2026 national total is 7.10 RVUs in an office setting and 6.25 RVUs in a facility.

Pabau’s claims management software scrubs each claim for missing or invalid details before submission, so fewer 28470 claims come back denied.

CPT code 28470: Official descriptor and procedure overview

CPT code 28470 reports closed treatment of a metatarsal fracture that needs no manipulation, once for each bone treated. The official descriptor reads: Closed treatment of metatarsal fracture; without manipulation, each. The American Medical Association (AMA) places it in the foot and toes fracture and dislocation range, 28400-28675. Its neighbors are 28475, with manipulation, and 28476, percutaneous skeletal fixation with manipulation.

Three terms in the descriptor carry precise clinical and billing meaning:

• Closed treatment: No surgical opening of the fracture site. The bone is managed without incision.
• Without manipulation: No physical reduction, realignment, or repositioning of fracture fragments. The fracture is immobilized in its presenting position.
• Each: The code is reported once per metatarsal bone treated. Multiple fractured metatarsals on the same foot are reported as multiple units, subject to NCCI edits.

The word “each” is easy to overlook. If a patient fractures the second and third metatarsals and both are treated without manipulation in the same session, report CPT 28470 with two units. Check current National Correct Coding Initiative (NCCI) edits before billing multiple units, as payer-specific rules apply.

Which metatarsals does CPT 28470 cover?

CPT 28470 applies to any of the five metatarsal bones, first through fifth. The descriptor simply reads “metatarsal fracture” and doesn’t differentiate by bone. The fifth metatarsal is the bone most often coded under 28470. Avulsion fractures at its base often present without significant displacement and are managed conservatively.

One code per bone is the governing billing principle, because each treated metatarsal fracture is a separately reportable service. The table below shows how multiple fractures at the same visit are handled:

CPT 28470 vs 28475 vs 28476: Choosing the right code

The split between CPT 28470, 28475, and 28476 turns on what the note documents. Whether the fracture was manually reduced decides 28470 versus 28475. Fixation only matters for 28476, the percutaneous skeletal fixation code, which always includes manipulation.

Coding errors here usually involve 28470 claims whose note contains phrases such as “fracture realigned,” “position corrected under fluoroscopy,” or “traction applied to restore alignment.” Any of those phrases documents manipulation, so 28475 is the correct code. When the note simply states “fracture immobilized in a short leg cast” or “boot applied, fracture non-displaced,” CPT 28470 stands. Run every note through the same two questions, in this order:

One injury pattern falls outside all three codes. If a metatarsal fracture comes with a tarsometatarsal dislocation that is reduced through an open incision, the procedure code is 28615 instead.

What a 28470 note must document

A CPT 28470 note must establish three clinical facts: the fracture is confirmed, no manipulation was performed, and which immobilization method was used.

• Imaging confirmation: X-ray or other imaging confirming the fracture and its displacement status. Non-displaced or minimally displaced findings support the without-manipulation determination.
• Clinical assessment: Provider documentation of fracture location (which metatarsal), laterality (left or right foot), and neurovascular status of the affected extremity.
• Treatment description: Explicit statement that no manipulation, reduction, or realignment was performed. Describe the immobilization method, such as a short leg cast, walking cast, cast boot, or surgical shoe.
• Follow-up instructions: Weight-bearing status, activity restrictions, and the scheduled follow-up visit. These support medical necessity and fit the 90-day global period expectations.

Cast application doesn’t change code selection. Under CMS global surgery policy, casting and splinting performed at the same session as CPT 28470 are included in the global package. Separately billing a 29000-series casting code on the same date typically creates an NCCI conflict. Verify the current edit table annually, as bundling rules update each year.

ICD-10 codes that pair with CPT 28470

The primary ICD-10-CM code family for metatarsal fractures is S92.3-. Codes in this family specify laterality and displacement. A nonspecific or mismatched diagnosis code is a common reason CPT 28470 claims are denied.

Always apply the seventh character correctly: A for the initial encounter (active treatment), D for a subsequent encounter (routine healing), and S for sequela. Submitting an “A” code on a follow-up visit, or a “D” code at the initial treatment, is a common ICD-10 error on CPT 28470 claims. The CDC/NCHS ICD-10-CM web tool provides the current-year tabular list and a searchable index.

Modifiers for CPT 28470

Modifier selection for CPT 28470 depends on laterality, whether multiple bones are treated, and the place of service.

• Modifier -LT / -RT: Required by most payers to show the left or right foot, so apply one to every CPT 28470 claim. The -LT/-RT modifier and the laterality in the ICD-10 code should agree.
• Modifier -50 (bilateral): Used when the same procedure is performed on both feet in the same session. Medicare typically expects a single 28470-50 line billed as one unit. Separate 28470-LT and 28470-RT lines are a commercial-payer variation, so confirm each payer’s preference before submission.
• Modifier -59 (distinct procedural service): Used when 28470 is reported with a different code on the same date for the same foot. A typical case is 28470 on one metatarsal and 28475 on another. A second metatarsal treated without manipulation is reported as a second unit of 28470 instead. Add -59 there only if the payer or an NCCI edit requires it.
• Modifier -24 (unrelated E/M during postoperative period): Required on an evaluation and management (E/M) visit billed during the 90-day global period. It applies when the visit is for a condition unrelated to the fracture. Without it, the E/M claim is denied as part of the global package.
• Place of service (POS): CPT 28470 may be performed in an office (POS 11), ambulatory surgery center (POS 24), or hospital outpatient department (POS 22). The setting changes the Medicare rate. Non-facility (office) rates are higher because the practice absorbs the overhead costs.

The 90-day global period and postoperative care

CPT 28470 carries a 90-day global surgical period, assigned by CMS under global period indicator “090.” All routine postoperative care related to the fracture is bundled into the single CPT 28470 payment for 90 days after the procedure date.

What the global period includes, and what can still be billed separately, often causes confusion:

• Included in global (cannot separately bill): Follow-up visits directly related to the fracture, cast changes, splint adjustments, and routine fracture monitoring visits. Casting performed at the same session as 28470 is bundled under CMS global surgery policy.
• May be separately billable: E/M services for a new or unrelated condition during the global period (use modifier -24). Casting supplies for materials only, reported with HCPCS casting supply codes in the Q4001-Q4051 range rather than 29000-series codes, after checking current NCCI edits. Complications that need a return to the operating room (use modifier -78).
• Post-global period: Services rendered after day 90 are no longer part of the global package and bill normally.

Tracking 90-day global periods by hand in a busy podiatry or orthopedic practice invites denials. Keep a list of every 28470 date of service with its day-90 end date, and check it before any E/M claim goes out. Making that check a fixed step in your medical billing workflow catches these errors before the payer does.

Medicare and commercial payer reimbursement

Medicare reimbursement for CPT 28470 is calculated with the Relative Value Unit (RVU) system under the Medicare Physician Fee Schedule (MPFS). The rate varies by year and by place of service. Facility rates are lower than non-facility rates because the facility bills its own costs separately.

These are the 2026 national RVUs from the CMS fee schedule file. Your payment multiplies them by your locality’s geographic practice cost index (GPCI) and the annual CMS conversion factor. Use the CMS Physician Fee Schedule lookup tool for current national and locality-adjusted rates. For a quick wRVU lookup, FastRVU’s free 2026 RVU lookup lists work, PE, and malpractice RVUs by code.

Commercial payer rates for CPT 28470 are set by contract and often expressed as a percentage of MPFS (for example, 115% of Medicare). Workers’ compensation rates follow each state’s own fee schedule and can’t be generalized. Practices billing 28470 to many workers’ compensation payers should check the applicable schedule with each state’s workers’ compensation board.

Common denial reasons and how to avoid them

Most CPT 28470 denials follow a handful of repeatable patterns, so podiatry and orthopedic billing teams can check for each one before submission.

• Wrong code selected (should be 28475): The note contains manipulation language. Fix: Audit the note before coding. If the word “reduced,” “realigned,” or “manipulated” appears, use 28475.
• Missing or incorrect ICD-10 laterality: The claim carries an unspecified S92.30- code when a laterality-specific code is available and required. Fix: Code to the highest level of specificity, including right vs. left foot and displaced vs. non-displaced.
• Incorrect seventh character: “A” (initial encounter) used on a follow-up visit, or “D” used at the first treatment. Fix: Map the encounter type to the correct seventh character at every visit.
• Global period violation: An E/M visit billed during the 90-day period without modifier -24, or a fracture follow-up billed when it’s already bundled. Fix: Check each E/M claim against your list of patients within 90 days of a 28470 procedure.
• Unbundling cast codes: Separately billing a 29000-series cast code on the same date as 28470. Fix: Review the NCCI edit table for the current year before billing casting codes alongside fracture codes.
• Missing imaging documentation: Payer audits often request x-ray or imaging reports confirming the fracture and the non-displaced finding that justifies conservative treatment. Fix: Attach or reference imaging in the clinical note.

Effective denial management in healthcare starts with pre-submission claim scrubbing. Running CPT 28470 claims through validation checks before they reach the payer cuts avoidable denials. The clean claim standard, a claim with no errors at first submission, should be the target for every 28470 case.

When a 28470 claim is denied anyway, the remark code on the remittance tells you why. Our guide to medical billing denial codes explains CO-4, CO-97, and how to appeal them.

Does CPT 28470 need prior authorization?

Usually not. Most commercial payers don’t require prior authorization for CPT 28470, because closed treatment without manipulation is widely considered medically necessary when imaging confirms the fracture. Medicaid managed-care plans and workers’ compensation carriers often set their own authorization rules, so don’t assume.

Before treating, verify benefits for the specific plan. Key questions to ask the payer’s provider services line:

• Is CPT 28470 on the payer’s prior authorization required list for this plan?
• Does authorization extend to both initial and follow-up visits within the global period?
• For workers’ compensation: Has the employer’s insurer issued a claim number and authorized treatment?

Workers’ compensation billing for CPT 28470 requires a claim number from the employer’s carrier before services are rendered. State fee schedules apply rather than commercial rates. Some states also require documentation of work-relatedness, meaning a description of the injury mechanism that connects the metatarsal fracture to the workplace incident.

How claims management software reduces 28470 denials

Podiatry and orthopedic practices billing CPT 28470 at volume juggle four risks on every claim. Manipulation language, the 90-day global period, bilateral modifiers, and ICD-10 laterality all land on the same claim. One error on any of them earns a denial or an audit flag.

Pabau, the practice management platform we build, keeps the treating provider’s notes and the claim on one patient record. Its podiatry claims management software scrubs every claim for missing or invalid details before it leaves Pabau. A claim that fails comes back flagged “Needs action,” with a link to the field that needs fixing.

Claims go out through Pabau’s Claim.MD integration as electronic CMS-1500 claims, reaching thousands of US payers. Real-time eligibility checks run from the patient record before the visit. Remittance advice flows back into the claims dashboard and is matched to the claim it settles. Our 837 file guide explains the electronic claim standard that clearinghouses work with.

Reduce CPT 28470 denials before they happen

Pabau scrubs every claim for missing or invalid details before submission. Your podiatry or orthopedic billing team fixes 28470 errors before a payer sees them, not after a denial.

Book a demo

Conclusion

CPT 28470 rewards the practice whose notes say plainly what was not done. Write “no reduction performed” alongside the bone and the foot, and the code holds up at audit. Leave it vague, and the payer ends up choosing between 28470 and 28475 for you.

The trade-off is a few extra words at the point of care. They cost the provider seconds and save the billing team a denial, an appeal, and weeks of rework inside the 90-day global period.

Start with your next five 28470 notes and check each one against the two coding questions above. Book a demo to see how Pabau keeps fracture notes and scrubbed claims on the same patient record.

Continue your research

Want to understand how clearinghouse submissions work? Medical claims clearinghouse guide explains how claims move from practice to payer and where errors are caught.

Billing multiple codes on the same date? Denial codes in medical billing covers CARC codes, CO-4, CO-97, and how to appeal common bundling denials.

Filling in a paper claim for a fracture visit? CMS-1500 form template shows where the CPT code, modifiers, units, and ICD-10 pointer go on the claim.

Treating a workers’ compensation or Medicaid patient? Prior authorization process walks through how to request approval before treatment and what payers ask for.

Coding fractures alongside other procedures? Medical coding cheat sheet puts common CPT, ICD-10, and modifier rules on one reference page.

Frequently asked questions