Broken bone treatment cost by fracture type

Six layers behind one broken bone

A fracture produces claims from several directions, and each is priced by its own part of the Medicare system. The emergency or urgent care visit has a code for the encounter. The X-ray splits into the pictures and the reading. A splint or cast has a code of its own, unless the clinician who treats the fracture is the same one who applied it. The treatment of the fracture is another code, and its price already contains 90 days of follow-up. A hospital sends a separate facility claim under the outpatient payment system. If surgery is involved, anesthesia and sometimes an assistant surgeon add professional claims.

The fracture code is where the price moves most, and it moves in steps. For the wrist, the office anchor starts at $388.37 for closed treatment without manipulation (25600) and rises to $652.52 when the code says the clinician manipulated the bone. Open surgical codes have no office amount at all, and run from $729.17 to $1,017.02 at the facility rate. The hospital side steps even harder: $252.01 for 25600 as a hospital outpatient service, $1,642.82 for 25605 and $7,413.38 for the open codes.

Those are Medicare fee schedule and outpatient payment system amounts. They are not hospital list prices, which are a different number again and are not what a patient pays. The physician amounts come from the CMS 2026 relative value file for Michigan Locality 01 (Detroit) at a $33.4009 conversion factor, the hospital amounts are national unadjusted, and the sections below say how each is built so another locality or another hospital can be compared.

The fracture ladder, bone by bone

Each bone has a ladder of codes, and a bill's code tells you which rung was billed. Closed treatment without manipulation is the lowest rung. Closed treatment with manipulation is the next, where the code describes the clinician realigning the fracture by hand. At the top are the open treatment codes, which describe surgery through an incision with internal fixation, and in the wrist a percutaneous code sits between. These are billing meanings of the codes, and the table does not say which rung any person's fracture needs.

Source: CMS PFS RVU26D (PPRRVU2026_Oct_nonQPP, released 08/26/2026) and GPCI2026, Michigan Locality 01, $33.4009 conversion factor; CMS OPPS Addendum B, October 2026 update, national unadjusted payment rate. All 16 codes carry a 090 global period in the file. Computed and checked November 3, 2026. Medicare anchors, not your bill.

The office rate is the physician fee schedule amount when the service happens in a setting such as a private office or an urgent care center (place of service 11 or 20). The facility rate applies when the claim's place of service is a hospital outpatient department, an emergency room or a surgery center. Chapter 12, section 20.4.2 of the Medicare Claims Processing Manual lists both groups of settings, among the facility ones 19, 22, 23 and 24. In the file, 7 of the 16 codes show NA in the nonfacility column, and they are the percutaneous and open treatment codes. The file defines NA as a procedure rarely or never performed in that setting, so an open repair has a facility amount only, and 9 codes have both.

The hospital column reads differently from the physician columns. Status T means a separate payment with a multiple procedure reduction. Status J1 means a comprehensive payment that absorbs the other hospital services on the claim. The ladder's T codes are 23500, 25600, 27786, 27788, 27808, 28490, and its J1 codes are 23505, 23515, 25605, 25606, 25607, 25608, 25609, 27792, 27810, 27814. One result follows from that: a wrist realigned in a hospital outpatient department (25605) is paid $1,642.82, which is 6.5 times the $252.01 paid for the same wrist without manipulation (25600), while the physician's facility-rate fee rises from $346.47 to $570.33, 1.6 times. Whether manipulation was billed moves the hospital's line far more than the clinician's.

The same pattern holds for the ankle. The two-malleolus codes run 27808 at $326.20 (facility rate), 27810 at $482.27 and 27814 at $750.67, which makes open treatment 2.3 times the no-manipulation code for the surgeon. The hospital's lines for those three codes are, in order: T, APC 5111, $252.01; J1, APC 5112, $1,642.82; and J1, APC 5114, $7,413.38. By the hospital outpatient figures, open treatment is 29.4 times the no-manipulation code.

The collarbone and the great toe fill out the ladder. Collarbone closed treatment without manipulation (23500) is $262.50 at the office rate, and open treatment with fixation (23515) is $713.04 with a hospital line of $7,413.38. The great toe code in the table (28490) is the cheapest rung on the page at $158.53 at the office rate and $133.06 at the facility rate. It still carries a 90-day global period, the same as the surgical codes.

Where the 2.71 work units of 25600 go

Code 25600 has 2.71 work relative value units in the CMS file, a 090 global period, and nonfacility and facility practice expense units of 8.28 and 6.98. Its malpractice units are 0.55. The payment formula in the file's documentation multiplies each of the three unit types by that locality's cost index, adds them, and multiplies by the conversion factor.

For Detroit, the work index is 1.000, so the work units stay 2.71000. The nonfacility practice expense is 8.28 x 0.965 = 7.99020, the malpractice units are 0.55 x 1.686 = 0.92730, and the three add to 11.62750 adjusted units. Times $33.4009, that is $388.37. At the facility rate the practice expense is 6.98 x 0.965 = 6.73570, the total is 10.37300 adjusted units, and the amount is $346.47.

The work units alone are worth 2.71 x $33.4009 = $90.52. That is the part of the fee that pays for the clinician's time and effort across the whole package, including the pre-visit, the treatment and the follow-up. The practice expense units pay for the staff, space and supplies behind it, and the difference between the office and facility columns is practice expense only: 8.28 units at the office rate against 6.98 at the facility rate, which is $41.90 less at the facility rate. The file's documentation says the facility practice expense values are used for services performed in hospital outpatient settings, emergency rooms and surgery centers, where the facility has its own claim.

For the manipulation code 25605, the work units are 6.09, worth $203.41 at $33.4009. The step from 25600 to 25605 therefore adds 3.38 work units, or about $112.89 of work value, before any change in practice expense. The file defines the 090 period as a major surgery with a 1-day preoperative period and a 90-day postoperative period included in the fee schedule amount, so the work units price the whole package and not one visit.

Two conversion factors appear in the 2026 file set. The nonQPP file used for every physician amount on this page lists $33.4009, the factor for clinicians who are not qualifying alternative payment model participants, and the QPP file lists $33.5675 for those who are. The anchors here use the first.

Ninety days of follow-up inside one code

Medicare treats the codes with a 090 global period as major surgery. In the claims manual's words, when the global period is determined for a major surgery, contractors "count 1 day immediately before the day of surgery, the day of surgery, and the 90 days immediately following the day of surgery." The manual's example puts surgery on January 5 and ends the postoperative period on April 5. A closed wrist fracture treated on a Monday therefore starts a three-month stretch in which related follow-up by the same practice is already paid for.

Chapter 12, section 40.1, lists what the package includes when the physician who treats the fracture furnishes it: preoperative visits after the decision is made to operate, intra-operative services, complications that do not require a return to the operating room, follow-up visits that relate to recovery, post-surgical pain management by the surgeon, supplies except those identified as exclusions, and miscellaneous services such as dressing changes and the removal of casts and splints. It lists what the package does not include, and the exclusions are the part that shows up on statements.

Source: Medicare Claims Processing Manual, chapter 12, sections 40.1 and 40.2 (table of contents revision 13753, issued 05-07-26). Rules for Original Medicare. Checked November 3, 2026.

The X-ray row is the one that changes a patient's total. Under Original Medicare, each follow-up film bills under the imaging codes in a later section, while the visit at which the cast is checked does not bill. Code 99024 exists for that visit: the file lists it as a postoperative follow-up visit with status B and zero units. The file defines status B as bundled, with any units shown not used for payment, so a 99024 line on a statement is a record that the visit happened inside the package.

The file also gives the package its internal shape. For all 16 fracture codes on this page, the file shows 0.10 for the preoperative part, 0.69 for the intra-operative part and 0.21 for the postoperative part. That split matters when two physicians share the care. Under the manual's rule for modifiers 54 (surgical care only) and 55 (postoperative management only), when physicians agree on a transfer of care, "A/B MACs (B) pay the appropriate percentage of the fee schedule payment." The surgeon with modifier 54 is paid the combined preoperative and intra-operative parts, and the physician with modifier 55 the postoperative part, with the post-operative share divided by days of responsibility if more than one physician provides it.

Take 25605 at the facility rate in Michigan Locality 01, $570.33, as a stated input for a case where one physician realigns the wrist and another takes over the follow-up under a written transfer of care. The first physician's share is $570.33 x 0.79 = $450.56, and the second physician's share is $570.33 x 0.21 = $119.77. The two add back to $570.33, the single-physician amount. Splitting the care does not add a charge under Medicare rules, and the manual states that when more than one physician furnishes services in the package, the sum approved for all of them may not exceed what a single physician would have been paid, with narrow exceptions it lists.

A second exception in section 40.2 covers emergency departments. The manual says physicians who give follow-up services for minor procedures performed in emergency departments bill the appropriate level of office visit code, and the physician who performs the emergency room service bills the surgical procedure without a modifier. That wording is about minor procedures, with global periods of 000 or 010. The fracture codes on this page are 090 major procedures, so the modifier 54 and 55 route is the one that applies to a handoff for them.

Splints and casts: when they bill

Splints and casts have their own codes, with a 000 global period each, and they are priced separately from the fracture code. The NCCI Medicare Policy Manual (chapter 4, section G, revision date 1/1/2026) sets when they may appear on the same claim as fracture care, and the answer is mostly that they may not.

Source: CMS PFS RVU26D and GPCI2026, Michigan Locality 01; CMS OPPS Addendum B, October 2026 update, national unadjusted. Computed and checked November 3, 2026. Medicare anchors, not your bill.

Chapter 4 says "CPT codes for closed, percutaneous, or open treatment of fractures or dislocations include the application of casts, splints, or strapping," and that the casting codes shall not be reported separately. It adds that casting, splinting and strapping codes are not reported separately if a service from the musculoskeletal surgery section is performed for the same anatomic area. For a patient, the rule has a practical meaning: if the same office bills a fracture code such as 25600 and also a cast code such as 29075 for the same wrist on the same date, the statement deserves a question to the billing office.

The cast codes do bill on their own in one pattern. The manual says that when a physician treats a fracture with a cast, splint or strap "as an initial service without any other definitive procedure or treatment and only expects to perform the initial care," the provider may report an evaluation and management service, a casting or splinting code, and a supply code from Q4001 to Q4051. Hospitals follow a parallel rule: the hospital reports the casting code, and "Payment for the cast/splint/strap supplies is included in the payment for the procedure reported." The manual adds that an emergency department visit may be reported with a casting code only if the visit is significant and separately identifiable. That is the pattern behind a splint put on in an emergency room: a visit, a splint, and a handoff to someone who bills the fracture code later.

The cast material itself has a price list. Cast supply codes are marked status X in the physician fee schedule file, a statutory exclusion with no physician fee schedule payment, and the DMEPOS fee schedule prices them in its splints and casts category. In Michigan, the October 2026 DMEPOS file lists $11.03 for an adult short arm cast in plaster (Q4009) and $24.80 in fiberglass (Q4010). A short arm splint is $8.59 in plaster (Q4021) and $15.50 in fiberglass (Q4022). For the leg, a short leg cast is $20.92 in plaster (Q4037) and $52.48 in fiberglass (Q4038), and a short leg splint is $14.79 in plaster (Q4045) and $23.79 in fiberglass (Q4046). Chapter 12, section 40.1, notes that splints and casting supplies are payable separately for services in a physician's office. The hospital's payment includes them: 42 CFR 419.2(b)(4) lists packaged supplies and "devices used for external reduction of fractures and dislocations."

These supply amounts are small next to the procedure lines, and a bill that shows a supply charge several times larger than the DMEPOS amount for the matching code is a reason to ask which code was billed. Whether a given office bills a supply code with a fracture code, and to which payer, is a question for its billing office. The manuals quoted here describe the initial-care-only pattern and the office exception in section 40.1, and they do not say what an office does with replacement casts, so that is another question to ask: whether a replacement cast during the 90 days is billed, and under which code.

X-rays: the picture and the reading

Every fracture starts with an image. The physician fee schedule prices each X-ray in three rows, a global row and two component rows: modifier TC for the technical component, the machine, the technologist and the room, and modifier 26 for the professional component, the reading and the report. At an office or urgent care center the claim may be the global code. At a hospital, the picture is the hospital's line and the reading is a physician's separate claim, as the guide to separate radiologist bills explains in detail.

Source: CMS PFS RVU26D and GPCI2026, Michigan Locality 01, nonfacility amounts, $33.4009 conversion factor; CMS OPPS Addendum B, October 2026 update. Computed and checked November 3, 2026. Medicare anchors, not your bill.

The global amounts run from $28.35 to $41.94 across the nine codes. The reading is the smaller piece in every row, from 21.0 percent of the global amount for 73110 to 27.6 percent for 73620. The 3-view wrist code (73110) is $41.94 and the 2-view wrist (73100) is $33.87, so the extra views are worth $8.07. For the ankle, 73610 is $36.46 against $31.93 for 73600.

In the hospital column, the figure is the same for all nine codes. Each carries status Q1 in APC 5521 at $88.91, whatever the number of views, which is a different logic from the physician fee schedule, where the views change the amount. Status Q1 is conditional. Addendum D1 defines it as a packaged payment when the code is billed on the same claim as a code with status S, T or V, and a separate APC payment in other circumstances. A wrist X-ray on a claim that also has a fracture code with status T has no separate payment, while a follow-up X-ray visit with no procedure on the claim does.

The CMS OPPSCAP file lists technical components that the Deficit Reduction Act caps at the outpatient amount. None of the nine codes in the table appears in the October 2026 file, so the picture amounts are the uncapped formula results. Under chapter 12, the professional piece is paid at the same amount whether the service is in a facility or not, which is why the 26 column has a single figure. The 5 percent professional component reduction and the 50 percent technical reduction for multiple imaging studies in one session apply to families of CT, MRI and ultrasound codes (indicator 4) and not to these plain X-rays, which carry indicator 0.

Hospital status codes decide the facility line

The hospital's claim is paid under the outpatient payment system, where each code gets a status indicator that says how it is paid. Four of them cover every hospital line on this page, and the definitions below are quoted from Addendum D1 of the CY2026 final rule.

Source: CMS CY2026 OPPS final rule Addendum D1 (status indicator definitions) and Addendum B, October 2026 update. Checked November 3, 2026.

The effect on a surgical claim is large. Under the J1 definition, the ankle repair's $7,413.38 covers the operating room, the recovery area, supplies and hardware, and any X-rays taken on that claim. 42 CFR 419.2(b) describes the packaged costs as those "integral, ancillary, supportive, dependent, or adjunctive to performing a procedure," and lists the use of an operating suite, the use of a recovery room, medical and surgical supplies, implantable items and intraoperative items and services. Addendum J lists the exclusions from that packaging, among them ambulance services, brachytherapy, pass-through drugs and devices, and therapy services reported on a separate recurring-services claim. Addendum J also lists pairs of comprehensive codes that move a claim to a higher APC, and no pair in that list starts with 27814.

A J1 claim has a cost-sharing rule too. Medicare.gov says that, in addition to the amount paid to the doctor, patients usually pay the hospital a copayment for each service in a hospital outpatient department, and "in most cases, the copayment can't be more than the Part A deductible for each service." The 2026 Part A deductible is $1,736. The highest minimum unadjusted copayment among the ladder codes is $1,482.68, for the J1 5114 line, which is below the cap; a line would reach the cap only if its payment passed $8,680. Critical access hospitals are the exception Medicare.gov names, where the copayment can exceed the deductible.

Two limits on the hospital figures belong next to them. They are national unadjusted: 42 CFR 419.43 has CMS adjust the labor-related portion of each payment and copayment by the hospital inpatient wage index for the hospital's area, so a hospital in a high-wage area is paid more than the printed rate and one in a low-wage area less. And the figures are the Medicare payment rates, not the hospital's list price. A chargemaster price printed in a hospital price file is a separate number and the reader should not treat it as what Medicare pays or what a patient owes.

Worked bill: a casted wrist

The inputs are stated and illustrative. An adult with Original Medicare breaks a wrist, goes to a hospital emergency department, and is seen at a level 3 visit (99283). The wrist gets a 3-view X-ray (73110) and a short arm splint (29125). A few days later an orthopedic office, a private practice that is not hospital-owned, takes over and treats the fracture in a cast without manipulation (25600), with a 3-view X-ray at two follow-up visits. Nothing else is billed. The figures are anchors from the tables above, and each claim stays in its own payment system.

Source: CMS PFS RVU26D and GPCI2026, Michigan Locality 01; CMS OPPS Addendum B, October 2026 update, national unadjusted, with the minimum unadjusted copayment used for the hospital share. Computed and checked November 3, 2026. The three claims are priced by different systems and are not added together. Medicare anchors, not your bill.

The physician side has two lines and a reading, and the reading may come from a radiologist's group on its own claim. In this example the emergency physician gives initial care and does not treat the fracture, which is the pattern in which the manual allows a splint code. It allows the visit to be reported with a casting code only when the visit is significant and separately identifiable, so a statement showing both lines is plausible but not automatic. The hospital lines are separately payable in this example because the claim has no status S, T or V code: 99283 is J2 and there is no J1 on the claim, and both 73110 and 29125 are Q1, which package only into S, T or V lines. Adding a status T line to the same claim would pull the X-ray into it.

The orthopedic office is where the 90-day package starts. The 25600 line is $388.37, and it includes the cast the practice applies and the cast checks that follow, because the same practice treats the fracture and assumes the follow-up. The two follow-up X-rays are outside the package, and each bills as the global code at the office rate. The visits show no charge, or a 99024 line at zero. A cast supply code might also appear: the DMEPOS file prices an adult short arm fiberglass cast at $24.80 and a plaster one at $11.03. It is shown here as a line to ask about, not as part of the example.

Under Original Medicare, the patient share after the $283 2026 Part B deductible is 20 percent of each physician line, rounded line by line, and the hospital copayment for each service. If the deductible is still unmet when the first claim is processed, the first claims absorb it before the 20 percent applies, and the example above shows only the 20 percent step. Private plans and other payers use their own deductibles, copays and network rules, and the anchors only set the order of magnitude.

Now move the same 25600 to a hospital-owned orthopedic clinic, billed as a hospital outpatient department. The physician's line drops from the office rate of $388.37 to the facility rate of $346.47, and the hospital adds its own line: T, APC 5111, $252.01, with a minimum unadjusted copayment of $50.41. The X-ray taken at the same visit is a Q1 line that packages into the status T fracture line, while a follow-up film on a day with no procedure on the claim is separately paid at $88.91 national unadjusted. The guide to facility fees explains why that second claim exists, and the comparison in surgery center versus hospital outpatient cost shows the same split for planned procedures.

Worked bill: a surgically fixed ankle

The second example uses a two-malleolus ankle fracture with a surgical fix. The inputs are stated and illustrative. An adult with Original Medicare goes to a hospital emergency department and is seen at a level 4 visit (99284), with a 3-view ankle X-ray (73610) and a short leg splint (29515). The splint is temporary. A few days later the surgeon treats the fracture in a hospital outpatient department with open treatment and internal fixation (27814), and the patient goes home the same day. That is two hospital claims on two dates, not one.

Source: CMS PFS RVU26D and GPCI2026, Michigan Locality 01; CMS OPPS Addendum B, October 2026 update, national unadjusted, with the minimum unadjusted copayment as the hospital share. Anesthesia and any assistant surgeon are not priced here. Computed and checked November 3, 2026. The claims are priced by different systems and are not added together. Medicare anchors, not your bill.

On the emergency claim, the splint line is status T, so the 73610 X-ray, which is Q1, packages into it and gets no separate payment. The hospital's two payable lines are $426.30 and $166.02. Compare the wrist example, where the splint was Q1 and every line was separately paid. The same X-ray is paid or packaged depending on which other codes are on its claim, and that is why two hospital bills for similar injuries can have different line counts.

The surgery claim is where the amounts diverge. The surgeon's 27814 line is $750.67, which covers the pre-visit, the operation, the cast or splint care afterwards, and 90 days of related follow-up. The hospital's line is $7,413.38 under APC 5114, 9.9 times the surgeon's. For the patient under Original Medicare, the minimum unadjusted copayment on that line is $1,482.68, against the surgeon's 20 percent of $150.13. The hospital copayment is below the $1,736 Part A deductible cap. Anesthesia is a third professional claim, priced by time and base units, and the guide to how an anesthesia bill is calculated shows that arithmetic. The file marks 27814 with assistant-at-surgery indicator 2, which means an assistant at surgery may be paid, and the guide to the assistant surgeon bill prices that line. The closed-treatment codes in the ladder carry indicator 1, a statutory restriction on paying for an assistant at surgery.

The same ankle treated closed, without manipulation (27808), would show a surgeon's facility-rate line of $326.20 and a hospital outpatient line of T, APC 5111, $252.01. Open treatment raises the surgeon's line by $424.47 and the hospital's by $7,161.37. By these anchors, most of the difference between the two ankle bills is on the hospital's side of the ledger, not the surgeon's.

Follow-up is where the 90-day package is easiest to misread. After surgery, the surgeon's office sees the patient for a check and an X-ray at intervals. With a freestanding office billing the global X-ray code, three films come to $109.38, and the visits themselves are in the 27814 line. A physical therapy course after the cast or boot is billed on its own and is priced in the physical therapy cost guide. If the surgeon's practice is hospital-owned, the clinic's X-ray becomes a hospital line, and the fee schedule amounts above change to the facility pattern.

The itemized statement is where the ladder can be checked. A 27814 line should match the operative note, and the hospital's claim should show the J1 line with its other services packaged. The NCCI manual says casting and splinting codes are not reported separately with a fracture code for the same area, so a 29515 splint line from the surgeon on the day of the operation is a line to ask about. The itemized bill check has the steps.

When a cast turns into an operation

Treatment sometimes moves up the ladder. A fracture first treated in a cast can later need surgery, and the billing rules say what happens to the lower rung. Section 40.1 of chapter 12 lists, among the services not in the global package, "If a less extensive procedure fails, and a more extensive procedure is required, the second procedure is payable separately." The NCCI manual covers the same-day version: if a closed fracture treatment fails and is converted to an open procedure at the same encounter, only the more extensive open procedure is reportable.

Chapter 4 of the NCCI manual adds three more rules that decide how many fracture lines can appear. When a fracture is repaired, only one fracture repair code may be reported for an anatomic site, and closed, percutaneous and open codes for the same site are mutually exclusive. If one cast, splint or strap treats multiple closed fractures without manipulation, only one closed treatment code without manipulation is reported. And if a single cast treats multiple fractures without manipulation along with at least one that required manipulation, a code for closed treatment without manipulation is not reported separately.

Fractures at two different sites are a different case. The file gives the fracture codes multiple procedure indicator 2, under which a procedure reported on the same day as another is ranked by fee schedule amount and reduced, with the documented sequence of 100 percent, then 50 percent for each later procedure. A wrist and an ankle treated on the same date are two anatomic sites with two codes, so the lower-ranked one is reduced under that rule. Status T in the outpatient system carries its own multiple procedure reduction, as the status table above quotes. The sum of two single-injury bills is therefore not the expected total for a patient with two injuries treated on one date.

Four localities, same fracture codes

The physician amounts above are for Michigan Locality 01. Another locality multiplies the same units by different indices, so the dollars move while the codes stay the same.

Source: CMS PFS RVU26D and GPCI2026 (Addendum E, CY2026 final rule), $33.4009 conversion factor. Computed and checked November 3, 2026. Medicare anchors, not your bill.

The ankle repair at the facility rate is $654.88 under the Mississippi indices and $825.20 under the Manhattan indices, a spread of $170.32. Three indices produce that spread. The practice expense index adds $90.48 (Manhattan 1.162 against Mississippi 0.861), the malpractice index adds $57.71 (1.586 against 0.739), and the work index adds $22.12 (1.064 against 1.000). Each term is rounded on its own, so the three can differ from the spread by a cent.

Hospital figures are not in this table because they are not computed this way. The outpatient rates in Addendum B are national unadjusted amounts. Under 42 CFR 419.43, CMS adjusts the labor-related portion of the payment and copayment by the hospital inpatient wage index for the hospital's area. Each hospital's actual Medicare payment for a J1 ankle repair is therefore above or below $7,413.38 depending on where it is. Every rate here is a CY2026 rate. CMS published CY2027 proposed rules in July 2026 for the physician fee schedule (CMS-1848-P) and the outpatient system (CMS-1850-P). On November 3, 2026, CMS's notice pages for both systems listed those proposed rules and no CY2027 final rule.

Paying without insurance: what to ask

Fracture care has no verified self-pay range on this site, and the Medicare anchors are not what an uninsured patient is quoted. Hospital list prices are a third number and are not a patient's price either. The practical question is what each office will charge for the exact codes, in writing. The questions below follow the ladder and the bundling rules above.

• Which code is billed for the fracture itself, and which rung of the ladder is it? A closed-treatment code, a manipulation code and an open treatment code are priced very differently.
• Does the price include the 90 days of follow-up visits and the cast checks, and are follow-up X-rays billed on top?
• Is the X-ray billed as one global line, or as a picture and a separate reading from a radiologist?
• Is the splint or cast billed on its own code, and are cast supplies a separate line?
• For surgery, what does the facility quote cover: the operating room, recovery, hardware and the X-rays taken that day? Are the surgeon, the anesthesiologist and any assistant surgeon quoted separately?
• If a replacement cast is needed during the 90 days, is it billed, and under which code?

For a scheduled operation, the guide to the cash price request has wording for each question, and the guide to Good Faith Estimates explains when a written estimate is owed. Comparing a cash quote with using coverage is covered in pay cash or use insurance, and a hospital's assistance program is covered in hospital financial assistance. The emergency visit that usually comes first has its own ladder: emergency room visit levels prices the five visit codes and urgent care visit billing prices the walk-in alternative. A cut instead of a break is priced in stitches by wound length.

Broken bone cost questions

Fee files, manuals and rules behind these figures

• CMS, Physician Fee Schedule relative value file RVU26D (PPRRVU2026_Oct_nonQPP and PPRRVU2026_Oct_QPP, released 08/26/2026, the newest 2026 file on CMS's relative value file index), with the CY2026 GPCI file (Addendum E), the OPPSCAP file and the file documentation: work, practice expense and malpractice units, global period and its pre, intra and post percentages, status codes, the assistant-at-surgery and multiple procedure indicators, the PC/TC indicator definitions, and the $33.4009 and $33.5675 conversion factors. Computed and checked November 3, 2026.
• CMS, OPPS Addendum A and B updates: the October 2026 Addendum B (file dated 10/14/26, newest on the page) and the CY2026 final rule addenda zip, including Addendum D1 (status indicator definitions) and Addendum J (comprehensive APC ranking, complexity adjustments and exclusions). Payment rates, relative weights and APCs for the codes on this page are identical in the two Addendum B files. Checked November 3, 2026.
• CMS, DMEPOS fee schedule, October 2026 (dme26-d): cast and splint supply codes Q4009 to Q4046, Michigan non-rural amounts. Checked November 3, 2026.
• CMS, Medicare Claims Processing Manual, chapter 12 (table of contents revision 13753, issued 05-07-26): section 20.4.2 (site of service payment differential), section 40.1 (global surgical package), section 40.2 (modifiers 54, 55 and 57, emergency department follow-up) and section 40.4 (split global care percentages). Checked November 3, 2026.
• CMS, NCCI Medicare Policy Manual, 2026, chapter 4, section G (fractures, dislocations and casting, splinting and strapping; revision date 1/1/2026). Checked November 3, 2026.
• eCFR, 42 CFR 419.2 (basis of payment, packaged costs) and 42 CFR 419.43 (adjustments to national program payment and beneficiary copayment amounts, wage index). Version dated October 28, 2026, checked November 3, 2026.
• Medicare.gov, Medicare costs ($283 Part B deductible, $1,736 Part A deductible), Outpatient hospital services (hospital copayment and its cap) and Emergency department services. Checked November 3, 2026.
• AAPC Codify, CPT 27808, 27814, 27786 and 28490: plain-language summaries of what the ankle and great toe codes cover; the CMS files print the same short descriptor for every ankle code. The rows for 27788, 27792 and 27810 and the view counts on the X-ray rows are CPT descriptor wording that the CMS files do not print (they show, for example, "Treatment of ankle fracture" and "X-ray exam of wrist"). CPT descriptors are American Medical Association text. Checked November 3, 2026.
• CMS, Physician fee schedule federal regulation notices and the Federal Register entries for the CY2027 physician fee schedule proposed rule and outpatient proposed rule: proposed, not final, as of November 3, 2026. Checked November 3, 2026.

General billing information, not medical, legal or insurance advice. Medicare anchors are not your bill, and a clinic's, a hospital's or a plan's own prices and allowed amounts can differ from them. Confirm your price in writing before service.