Closed treatment of a coccyx (tailbone) fracture without surgical intervention — pain management, activity modification, and supportive care to facilitate natural healing.

Verified May 8, 2026 · 5 sources ↓

Medicare: $213.10
Work RVU: 1.87
Global, days: 90
Region: Other

Drawn from CMSAAPCBedrockbilling

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 5 cited references ↓

Mechanism of injury and confirmed coccyx fracture diagnosis — clinical exam findings or imaging report
Treatment rendered: specific conservative measures (cushion, analgesics, activity restrictions) documented by name
Provider's intent regarding global follow-up care — document whether assuming or transferring the 90-day global
If imaging performed same day, document separately as a distinct service with its own findings noted
Any prior treatment at another facility (ED, urgent care) noted to support fracture care assumption and global split if applicable

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 51 Multiple procedures 52 Reduced services 54 Modifier 57 Decision for surgery 58 Staged or related 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 27200 covers non-operative management of a coccygeal fracture. No incision, no reduction maneuver — the code captures the clinical decision-making, examination, and treatment plan that initiates the global fracture care period. Typical treatment includes donut-cushion use, analgesics, and activity restrictions. Imaging to confirm the fracture is separately reportable if performed on the same date.

The 90-day global period starts on the date of service. That window absorbs all routine follow-up visits, wound checks, and repeat coccyx-related encounters. Billing a separate E/M during the global requires modifier 24 (unrelated condition) with documentation supporting the unrelated diagnosis. If the treating provider will not manage the follow-up personally, split the global using modifiers 54 and 55 — the treating clinician takes 54, the follow-up provider takes 55.

Splint or strapping supply codes are bundled when the billing provider assumes the follow-up global care. If the provider applies only an initial stabilizer and transfers care immediately — with no intention of managing the global — bill the E/M plus the supply code instead of 27200.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (1.87) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (6.38) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.87
Practice expense RVU	4.12
Malpractice RVU	0.39
Total RVU	6.38
Medicare national rate	$213.10
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$213.10
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI P2) Ambulatory surgical center (freestanding)	$135.54

Common denial reasons

The recurring reasons claims for CPT 27200 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Missing or vague fracture confirmation — chart lacks imaging reference or sufficient physical exam findings to support coccyx fracture diagnosis
Casting or strapping supply code billed alongside 27200 when provider assumed global care — NCCI bundles supplies into the fracture code
E/M billed same-day without modifier 25 when a separately identifiable evaluation was performed prior to initiating fracture treatment
Global period E/M billed without modifier 24 — payer flags as duplicate service within the 90-day window
ICD-10 diagnosis code mismatch — coccyx fracture requires a site-specific code (S32.2xx series); unspecified pelvis fracture codes invite medical necessity review

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Does 27200 require imaging on the same date?

No. The fracture can be diagnosed clinically. If X-rays are taken the same day, bill the imaging code separately — it is not bundled into 27200.

02Can the emergency department bill 27200 and then transfer the patient to orthopedics?

Yes, using the modifier 54/55 split. The ED or initial provider bills 27200-54 for the treatment portion; the orthopedic provider who assumes follow-up bills 27200-55 for the post-op management. Document the transfer of care explicitly in both records.

03Is a donut cushion or supply separately billable when using 27200?

No, if the billing provider is assuming the global follow-up. NCCI bundles supplies applied at the time of fracture care into the fracture code when the same provider manages the global period. The supply is separately billable only when the provider is not assuming global care and instead bills an E/M plus supply.

04Can you bill an E/M on the same day as 27200?

Yes, with modifier 25 — but only when a separately identifiable E/M service was performed for a reason beyond the fracture evaluation itself. The documentation must show a distinct decision-making process for the unrelated problem.

05What ICD-10 codes pair correctly with 27200?

Use the S32.2xx series for coccyx fractures (S32.2xxA for initial encounter, S32.2xxD for subsequent, S32.2xxS for sequela). Unspecified pelvic fracture codes will trigger medical necessity reviews at most payers.

06When does modifier 22 apply to 27200?

When the encounter required substantially greater work than typical — for example, a complex patient with severe comorbidities requiring extended examination and management planning. Attach a cover letter quantifying the additional time and complexity; payers rarely auto-approve modifier 22 without one.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures the mechanism of injury, confirmation method (clinical or radiographic), specific conservative interventions prescribed, and the provider's explicit statement of intent to assume or transfer the 90-day global. That documentation prevents the two most common denials: missing fracture confirmation and ambiguous global responsibility when a split-care scenario applies.

See how Mira captures CPT 27200 documentation