Closed treatment of an acetabulum (hip socket) fracture without manipulation — no surgical reduction, no adjustment of fracture fragments.

Verified May 8, 2026 · 5 sources ↓

Medicare: $450.91
Work RVU: 5.36
Global, days: 90
Region: Hip

Drawn from AAPCCMSGenhealth

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Explicit statement that no manipulation was performed — 'closed treatment without manipulation' must appear in the note
Imaging report (X-ray or CT) confirming acetabular fracture location and fracture pattern
Clinical rationale for conservative management, including patient weight-bearing status and activity level
Laterality documented (right or left hip) to support RT/LT modifier
Fracture site described with sufficient specificity to support ICD-10-CM diagnosis code selection
Any immobilization, restricted weight-bearing instructions, or assistive device orders documented in the plan

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 57 Decision for surgery 58 Staged or related 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 27220 covers closed, non-surgical management of an acetabular fracture where the provider stabilizes the injury without manipulating the fractured bone. No open incision, no percutaneous fixation, and no manual reduction are involved. The 90-day global period begins on the date of service and covers all routine fracture follow-up through day 90.

The code descriptor uses the plural 'fracture(s)', which is intentional: even if the orthopedist treats multiple acetabular fractures in the same hip at the same encounter, only one unit of 27220 is reported. Billing a second unit for additional fracture lines at the same anatomic site is a known audit trigger and will be bundled or denied under NCCI policy.

When a significant, separately identifiable E/M is performed on the same date — such as the initial evaluation where the decision to manage non-operatively is made — append modifier 57 to the E/M code. Modifier RT or LT should be appended to 27220 to indicate laterality unless the specific payer does not require it. If the encounter later escalates to open or percutaneous fixation, that subsequent procedure falls under modifier 58 (staged) or 78 (unplanned return for a related procedure) depending on whether the return to the OR was planned.

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 (5.36) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (13.5) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.36
Practice expense RVU	7
Malpractice RVU	1.14
Total RVU	13.5
Medicare national rate	$450.91
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	$450.91
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI G2) Ambulatory surgical center (freestanding)	$135.54

Common denial reasons

The recurring reasons claims for CPT 27220 get rejected.

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

Billing two units of 27220 for multiple fracture lines in the same hip — the descriptor's 'fracture(s)' language prohibits multiple units at the same anatomic site
Missing laterality modifier when the payer requires RT or LT, triggering a claim edit
E/M billed same-day without modifier 57, causing the E/M to be denied as included in the global package
Upcoding to 27222 (with manipulation) when operative note does not document that manipulation was performed
ICD-10-CM diagnosis code that does not match the specificity of the acetabular fracture pattern documented in imaging

Frequently asked questions

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

01Can I bill 27220 twice if the patient has two fracture lines in the right acetabulum?

No. The descriptor reads 'fracture(s)' — one unit of 27220 covers all acetabular fractures treated at the same anatomic site in a single encounter, regardless of fracture count. Billing a second unit will be bundled under NCCI policy.

02What modifier do I use when I also bill an E/M on the same day as 27220?

Use modifier 57 on the E/M when that visit represents the decision to manage the fracture conservatively. Modifier 25 applies to minor procedures with a 0-day global; 27220 carries a 90-day global, so modifier 57 is the correct choice here.

03What is the difference between 27220 and 27222?

27220 is closed treatment without manipulation — the fracture is managed conservatively with no reduction of bone fragments. 27222 requires documented manipulation or skeletal traction. Using 27220 when manipulation was performed, or 27222 when it was not, is a coding error that audit teams specifically look for.

04Does the 90-day global for 27220 include casting or splinting follow-up visits?

Yes. Routine follow-up visits, dressing changes, and cast checks within 90 days are included in the global package. Bill separately only for services unrelated to the acetabular fracture, appending modifier 24 to the E/M.

05Is laterality required on 27220 claims?

Clinically, yes — document right or left in the note every time. Append RT or LT on the claim; most payers require it, and omitting it is a common clean-claim failure for musculoskeletal fracture codes.

06If conservative management fails and the patient needs open reduction weeks later, what modifier applies?

Use modifier 58 if the escalation to open surgery was staged or anticipated. If the return to the OR was unplanned but related to the original fracture, use modifier 78. Never use modifier 79 for a procedure related to the original injury.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the explicit absence of manipulation, laterality, fracture pattern, weight-bearing restrictions, and the clinical rationale for conservative management directly from dictation. This prevents the most common audit flag on 27220 — operative or clinical notes that document a fracture without clearly confirming no manipulation occurred, leaving reviewers to assume the higher-paying 27222 was undercoded or the lower-paying 27220 was overcoded.

See how Mira captures CPT 27220 documentation