Open surgical repair of a posterior or anterior acetabular wall fracture using internal fixation hardware such as plates, screws, or pins.

Verified May 8, 2026 · 6 sources ↓

Medicare: $967.29
Total RVUs: 28.96
Global, days: 90
Region: Hip

Drawn from CMSNIHAAPCAcgme

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative report must identify the fracture as isolated posterior or anterior acetabular wall — not a column fracture — to justify 27226 over 27227 or 27228
Specify the internal fixation construct used (plate type, screw count, pin configuration) by name in the operative note
Pre-operative imaging (CT preferred) confirming wall fracture pattern should be referenced or attached; dictation should correlate imaging findings to intraoperative findings
Laterality must be documented and match the ICD-10 diagnosis code (right vs. left acetabulum)
Surgical approach should be named explicitly (e.g., Kocher-Langenbeck, ilioinguinal) — notes that say 'standard approach' flag on audit
Document any concurrent procedures performed at the same session with clear distinction to support separate billing 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 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

27226 covers open treatment of an isolated posterior or anterior acetabular wall fracture with internal fixation. The surgeon opens the hip, reduces the wall fragment, and secures it with plate-and-screw or pin constructs. This is the narrowest of the three acetabular ORIF codes — it applies only when the fracture is confined to the wall, not the column. When the fracture extends into a single column or crosses the acetabulum transversely, 27227 applies; when both columns are involved, 27228 applies. Choosing the wrong code in this family is a top audit trigger.

The 90-day global period covers the day-before visit, the operative session, and all routine post-op care through day 90. Any E/M visit in that window for an unrelated condition requires modifier 24. A separately identifiable E/M on the day of surgery requires modifier 25. Intraoperative fluoroscopy is integral to acetabular ORIF and should not be reported separately per NCCI policy — billing it separately will generate an edit.

ICD-10 diagnosis coding must specify laterality and fracture type (posterior wall vs. anterior wall). Pairing 27226 with a column fracture ICD-10 code when only a wall fracture was treated — or vice versa — is a common mismatch that triggers medical review. Confirm the fracture pattern in the operative report and on pre-op imaging reads before code selection.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	15.18
Practice expense RVU	10.54
Malpractice RVU	3.24
Total RVU	28.96
Medicare national rate	$967.29
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	$967.29
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,675.08

Common denial reasons

The recurring reasons claims for CPT 27226 get rejected.

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

Wrong code in the acetabular ORIF family — column or two-column fracture patterns billed as 27226 instead of 27227 or 27228
ICD-10 diagnosis specifies a column fracture while 27226 (wall-only) was billed, creating a CPT-to-diagnosis mismatch
Intraoperative fluoroscopy billed separately when it is integral to the ORIF procedure and bundled per NCCI policy
Post-op E/M visits within the 90-day global period billed without modifier 24 for unrelated conditions
Operative note lacks sufficient detail on fracture pattern or fixation method to support medical necessity review

Frequently asked questions

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

01What separates 27226 from 27227 and 27228?

27226 is for an isolated posterior or anterior acetabular wall fracture only. 27227 covers a single-column fracture or a fracture running transversely across the acetabulum. 27228 covers two-column fractures, T-fractures, or a column fracture combined with an associated wall fracture. If the wall fracture has any column involvement, you're out of 27226 territory.

02Can I bill fluoroscopy separately with 27226?

No. Per NCCI policy, radiologic guidance integral to the procedure — including intraoperative fluoroscopy used during acetabular ORIF — cannot be reported separately at the same encounter. Billing it separately will generate a bundling edit.

03What modifier applies if I do an unrelated E/M during the 90-day global?

Use modifier 24 on the E/M to indicate it is for a condition unrelated to the original acetabular fracture repair. Document clearly in the visit note why the encounter is unrelated to the surgical diagnosis.

04If the same surgeon performs a concurrent THA at the same session for an acute acetabular fracture, how is that coded?

Both 27226 (or the appropriate acetabular ORIF code) and 27130 (THA) can be reported when performed together in combined hip arthroplasty with acetabular fixation cases, as published literature identifies these as distinct concurrent CPT codes. List the higher-RVU code first and append modifier 51 to the secondary procedure. Verify payer-specific bundling rules before submitting.

05Does 27226 include cast or splint application?

Yes. Per NCCI fracture care policy, casting, strapping, or splinting applied as part of open fracture treatment is included in the surgical code and cannot be billed separately.

06What global period applies to 27226, and what does it include?

27226 carries a 90-day global period. It includes the day-before visit, the surgery itself, and all routine post-op care through day 90 — including office visits, dressing changes, and stitch removal related to the acetabular repair. Anything unrelated to the original procedure during that window requires modifier 24 (E/M) or modifier 79 (unrelated procedure).

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 wall location (posterior vs. anterior), fixation hardware type and configuration, surgical approach by name, and the correlation between pre-op imaging findings and intraoperative fracture pattern. That documentation prevents the most common denial for this code: a CPT-to-diagnosis mismatch where the chart doesn't clearly distinguish a wall fracture from a column fracture.

See how Mira captures CPT 27226 documentation