Closed treatment of an acetabular (hip socket) fracture with manual manipulation to restore bone alignment, with or without skeletal traction.

Verified May 8, 2026 · 7 sources ↓

Medicare: $915.52
Total RVUs: 27.41
Global, days: 90
Region: Hip

Drawn from CMSAAPCAMAEmedny

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Fracture classification and displacement degree confirmed by imaging (X-ray or CT)
Description of manipulation technique and forces applied to achieve reduction
Notation of whether skeletal traction was applied, and if so, the method and duration planned
Pre- and post-reduction imaging findings documenting alignment achieved
Mechanism of injury and clinical indication for closed rather than open treatment
Identification of the surgeon providing post-operative management (or modifier 54 justification if surgical care only)

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 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 54 Modifier 58 Staged or related 59 Distinct service 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 7 cited references ↓

27222 covers closed treatment of an acetabular fracture that requires manipulation — meaning the surgeon manually applies force or traction to achieve acceptable alignment without making a surgical incision. Skeletal traction may or may not be used to maintain that alignment during healing. This distinguishes 27222 from its companion code 27220, which is used when no manipulation is performed. The type of fracture (open/compound vs. closed) has no bearing on code selection; what matters is the treatment approach.

The 90-day global period includes the manipulation, any traction management, and all routine follow-up through day 90. Casting and splinting applied at the time of treatment are bundled — bill them separately only if a different provider applies them without any other definitive treatment. Services unrelated to the acetabular fracture during the global period require modifier 24 (E/M) or modifier 79 (unrelated procedure).

If the treating surgeon will not be providing post-operative management, append modifier 54 to indicate surgical care only, and the covering provider bills the post-op care with modifier 55. Acetabular fractures are high-energy injuries; document fracture pattern, displacement degree, mechanism of injury, and pre/post-reduction imaging findings to support medical necessity and defend against downcoding to 27220.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	13.76
Practice expense RVU	10.68
Malpractice RVU	2.97
Total RVU	27.41
Medicare national rate	$915.52
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	$915.52
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 27222 get rejected.

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

Downcoded to 27220 when documentation does not explicitly describe manipulation being performed
Casting or splinting billed separately when applied at the same session as the fracture treatment
Missing or inadequate post-reduction imaging documentation to support necessity of manipulation
Unrelated services billed in the 90-day global without modifier 24 or 79, triggering global period bundling denials
ICD-10 diagnosis code mismatch — fracture laterality or type inconsistent with procedure code

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What is the difference between 27220 and 27222?

27220 is used when the acetabular fracture is treated without manipulation. 27222 requires that manipulation — manual reduction with or without skeletal traction — was actually performed. If your note doesn't say manipulation was done, expect a downcode to 27220.

02Does the fracture have to be 'closed' (not compound) to use 27222?

No. The code type refers to the treatment approach, not the fracture type. A compound (open) acetabular fracture can still be treated with 27222 if closed manipulation is the chosen treatment. There is no required correlation between fracture type and treatment code.

03Can you bill a separate E/M on the same day as 27222?

Only if the E/M is significant, separately identifiable, and documented as such. Append modifier 25 to the E/M. A routine fracture assessment that leads directly to the manipulation does not qualify as a separately reportable E/M.

04Is casting included in 27222, or can it be billed separately?

Casting and splinting applied at the time of fracture treatment are bundled into 27222 per NCCI policy. You cannot bill them separately unless a different provider applies the cast with no other definitive treatment being provided.

05What modifier applies if the treating surgeon won't handle post-op care?

Append modifier 54 (surgical care only) to 27222. The provider taking over post-operative management bills with modifier 55. Split the global fee proportionally according to CMS guidelines.

06Can 27222 be billed bilaterally?

Bilateral acetabular fractures requiring manipulation on both sides in the same session can be reported with modifier 50. This is clinically rare given the mechanism of injury typically involved, so payers may scrutinize the claim — ensure imaging and operative documentation clearly support both sides.

07What happens if manipulation fails and open treatment is required during the same session?

Bill only the open treatment code (27226 or appropriate open acetabular code). The failed closed manipulation attempt is not separately reportable — do not stack 27222 with the open code for the same session.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the fracture classification, degree of displacement, manipulation technique, traction application (method and pin placement if skeletal), and pre/post-reduction alignment findings from the surgeon's dictation. That detail is what separates a clean 27222 from a downcode to 27220 — without explicit documentation of manipulation, reviewers default to the lower code.

See how Mira captures CPT 27222 documentation