Open treatment of a coccygeal fracture, including any necessary manipulation to reduce and stabilize the broken tailbone segment.

Verified May 8, 2026 · 6 sources ↓

Medicare: $496.67
Work RVU: 7.13
Global, days: 90
Region: Other

Drawn from CMSAAOSAoassn

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Imaging (X-ray, CT, or MRI) confirming coccygeal fracture and degree of displacement
Documented failure of or contraindication to conservative management (e.g., prolonged pain, failed injections, failed closed reduction)
Operative note specifying open surgical approach, reduction technique, and any internal fixation or stabilization used
Clear medical necessity narrative explaining why open treatment was required over closed or non-operative management
Pre-operative diagnosis linked to appropriate ICD-10 fracture code specifying laterality/sequela status (initial vs. subsequent encounter)
Post-operative plan documented in the operative report to support global period management

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 52 Reduced services 57 Decision for surgery 58 Staged or related 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27202 covers open surgical treatment of a coccyx (tailbone) fracture. This is a relatively uncommon procedure — most coccygeal fractures are managed conservatively or with closed manipulation — so 27202 is reserved for cases where open reduction is required, typically due to severe displacement, failed conservative management, or associated soft-tissue injury demanding direct surgical access.

The code carries a 90-day global period. That window covers the day-before decision visit (use modifier 57 if the E/M drives the surgery decision), the procedure itself, and all routine follow-up through day 90. Any visit unrelated to the fracture care during that period requires modifier 24. A staged or planned return for a related procedure — such as coccygectomy after failed fixation — uses modifier 58 and resets the global clock.

Site of service matters here. HOPD and ASC payments differ substantially; see the Site of Service comparison table. Because this is an infrequently billed pelvic fracture code, payers will scrutinize medical necessity documentation closely. Conservative treatment failure, imaging confirming displacement, and a clear rationale for open versus closed management must all be in the record before submission.

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 (7.13) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (14.87) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.13
Practice expense RVU	6.24
Malpractice RVU	1.5
Total RVU	14.87
Medicare national rate	$496.67
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	$496.67
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 27202 get rejected.

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

Lack of documented conservative treatment failure prior to open surgical intervention
Missing or inadequate imaging confirming fracture displacement sufficient to require open reduction
Operative note does not distinguish open treatment from closed manipulation, making the code unsupported
Medical necessity not established — payer policy may require prior authorization for open coccygeal fracture treatment
Global period billing errors: routine post-op E/M billed without modifier 24 or unrelated procedure billed without modifier 79

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01When is 27202 appropriate versus closed treatment of a coccyx fracture?

27202 is for open surgical treatment only. If you're managing the fracture with manipulation without open exposure, that's a different code. Open treatment is typically justified by severe displacement, failure of conservative care, or associated injury requiring direct access. Document that rationale explicitly — payers will ask.

02Does 27202 include fluoroscopy used during the procedure?

Intraoperative fluoroscopy is generally considered integral to the open fracture treatment and is not separately reportable under NCCI policy. Don't bill a separate radiology guidance code for imaging used to confirm reduction during the same operative session.

03Can I bill an E/M on the same day as 27202?

Only if the E/M is a separately identifiable service beyond the pre-operative assessment. Append modifier 25 to the E/M. If that visit is when you made the decision for this major surgery, use modifier 57 instead — modifier 57 applies to E/M visits that trigger a 90-day global procedure.

04How do I bill a coccygectomy if the open fracture treatment fails and the patient returns?

If you planned a staged return for coccygectomy, use modifier 58 on the subsequent procedure — it signals a staged or related procedure during the global period and resets the 90-day clock. If the return is unplanned and for a complication, modifier 78 applies. Don't invert these: 78 is unplanned/related, 79 is unrelated.

05What ICD-10 codes pair with 27202?

The S32.2 code family covers coccyx fractures. Use the seventh-character extension to specify encounter type: A for initial encounter for closed fracture, B for initial encounter for open fracture, D for subsequent encounter with routine healing, G for subsequent encounter with delayed healing, K for subsequent encounter with nonunion, and S for sequela. Match the encounter type to the clinical status at time of service — using the wrong seventh character is a common claim edit trigger.

06Is prior authorization typically required for 27202?

Many payers require prior authorization for open surgical fracture treatment of the coccyx given its rarity. Check payer-specific policies before scheduling. Submit imaging, documentation of conservative treatment failure, and the surgical plan with your auth request.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the operative approach, confirmation of fracture displacement, reduction technique, and the clinical rationale for open versus closed management directly from dictation. This prevents the most common audit flag for 27202: an operative note that doesn't document why open treatment was necessary or fails to describe the surgical technique in enough detail to distinguish it from a closed manipulation.

See how Mira captures CPT 27202 documentation