Fracture care · Hip

27227

Open treatment of acetabular fracture(s) involving the posterior wall, posterior column, or both, with internal fixation.

Verified May 8, 2026 · 5 sources ↓

Medicare
$1,489.35
Total RVUs
44.59
Global, days
90
Region
Hip
Drawn from CMSAMAAAOS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

  • Fracture pattern specified as posterior wall, posterior column, or posterior wall + posterior column combination
  • Surgical approach named explicitly (e.g., Kocher-Langenbeck, Gibson, or extensile posterior)
  • Imaging findings (CT pelvis) correlating fracture anatomy to operative findings
  • Internal fixation constructs documented — plate type, screw count, and placement
  • Intraoperative fluoroscopy or imaging confirming reduction quality
  • Neurovascular status of sciatic nerve documented pre- and post-operatively
  • Operative note distinguishes posterior from anterior column involvement to justify 27227 vs. 27228

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 62 Co-surgeons 74 Discontinued post-anesthesia 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 27227 covers open surgical treatment of acetabular fractures involving the posterior wall, posterior column, or a combination of both, with internal fixation. These are high-energy injuries — typically from motor vehicle trauma or falls from height — and the code reflects the complexity of exposing and reconstructing the posterior acetabular architecture through a Kocher-Langenbeck or similar approach.

The 90-day global period means that all routine post-op management, wound checks, and implant-related visits through day 90 are bundled. Unrelated E/M services in that window require modifier 24; a significant, separately identifiable E/M on the day of surgery requires modifier 25. If a planned staged procedure follows (e.g., conversion to THA), use modifier 58. An unplanned return to the OR for a related complication uses modifier 78; an unrelated return uses modifier 79.

Distinguish 27227 from 27228, which covers anterior wall/column fractures or transverse and T-type patterns. Coding the wrong variant is one of the most common audit triggers for acetabular ORIF claims. Operative notes must name the specific fracture pattern and confirm posterior approach anatomy to support 27227 over 27228.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU24.77
Practice expense RVU14.56
Malpractice RVU5.26
Total RVU44.59
Medicare national rate$1,489.35
Global period90 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

SettingMedicare rate (national)
Office (PFS non-facility)
Procedure performed in physician's office
$1,489.35
HOPD (APC 5114)
Hospital outpatient department
$7,413.38
ASC (PI J8)
Ambulatory surgical center (freestanding)
$4,897.46

Common denial reasons

The recurring reasons claims for CPT 27227 get rejected.

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

  • Fracture pattern documented as anterior or transverse — maps to 27228, not 27227
  • Operative note says 'standard approach' without naming the posterior approach — flags for audit
  • Missing correlation between preoperative CT fracture classification and intraoperative findings
  • Global period conflict: post-op E/M billed without modifier 24 for an unrelated condition
  • Upcoding flag when bilateral modifier 50 is appended — bilateral acetabular ORIF is exceptionally rare and will be reviewed

Frequently asked questions

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

01What is the difference between CPT 27227 and 27228?
27227 covers posterior wall and/or posterior column acetabular fractures treated open with internal fixation. 27228 covers anterior wall, anterior column, transverse, T-type, or combined anterior-posterior patterns. Choosing the wrong code based on a vague operative note is a direct audit trigger.
02Can 27227 and 27228 be billed together for a complex combined fracture?
Generally no — 27228 is intended to capture more complex combined patterns. Billing both simultaneously invites an NCCI bundling denial. If the fracture truly involves both anterior and posterior columns as separate distinct injuries requiring separate fixation, document that complexity and consider modifier 22 for increased procedural work rather than unbundling.
03What global period applies to 27227 and what does it include?
The global period is 90 days. It includes the day before surgery, the operative session, and all routine post-op visits, dressing changes, and hardware-related follow-up through day 90. E/M services for unrelated conditions in that window need modifier 24.
04When is modifier 22 appropriate with 27227?
Modifier 22 is appropriate when the procedure required substantially greater work than typical — for example, a comminuted posterior wall fracture with marginal impaction requiring bone grafting, or a patient with prior hardware creating significant technical difficulty. The operative note must describe the specific factors that added time and complexity, and a cover letter supporting the upcharge should accompany the claim.
05How should a same-day E/M be handled if the surgeon evaluates the patient in the ED before taking them to the OR?
If the decision to perform 27227 was made during that E/M encounter, use modifier 57 on the E/M code to indicate the visit was the decision-for-surgery visit. This bypasses the global package bundling rule for that E/M. Modifier 25 applies to a significant E/M on the same day as a minor procedure, not a major surgery like 27227.
06Can 27227 be billed with hip dislocation reduction codes on the same day?
Posterior acetabular fractures frequently occur with hip dislocation. If the dislocation was reduced prior to definitive ORIF at the same operative session, check NCCI edits carefully — reduction codes are typically bundled into the open treatment. Document the sequence and timing; if reduction occurred at a separate encounter (e.g., ED closed reduction before OR), that may support separate billing with appropriate modifiers.

Sources & references

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

  1. 01CMS Physician Fee Schedule 2026
  2. 02
    cms.gov
    https://www.cms.gov/national-correct-coding-initiative-ncci
  3. 03
    cms.gov
    https://www.cms.gov/files/document/2025nccimedicarepolicymanualcompletepdf.pdf
  4. 04
    ama-assn.org
    https://www.ama-assn.org/system/files/cpt-assistant-may2022-update-musculoskeletal.pdf
  5. 05
    aaos.org
    https://www.aaos.org/quality/resident-guide-to-coding-and-practice-management/coding-reimbursement-for-residents/coding-articles-for-residents/

Mira AI Scribe

Mira's AI scribe captures the fracture pattern classification (posterior wall, posterior column, or combined), surgical approach by name, fixation construct details, and sciatic nerve status from dictation. This prevents the most common 27227 denial: an operative note that fails to distinguish posterior from anterior column involvement, which auditors use to remap the claim to 27228.

See how Mira captures CPT 27227 documentation

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