Open surgical repair of complex acetabular fractures involving both anterior and posterior columns, including T-type, both-column, and single-column or transverse patterns with associated wall fracture, with internal fixation.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,685.74
Total RVUs: 50.47
Global, days: 90
Region: Hip

Drawn from CMSAAPCPayerpriceAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative note must identify the specific fracture pattern by name — T-fracture, both-column, or single-column/transverse with associated wall fracture — to justify 27228 over 27227
Document hardware type, placement sites, and fixation strategy used across both columns
Imaging (CT preferred) confirming two-column involvement or transverse-with-wall pattern should be referenced in the operative report
Approach(es) used must be named (ilioinguinal, Kocher-Langenbeck, combined, extended iliofemoral); audit flags notes that state only 'standard approach'
Document intraoperative fluoroscopy use and any bone graft application, as these may support additional billing or justify modifier 22 for unusual complexity
If performed with or around a hip arthroplasty (27130), clearly distinguish acetabular fracture fixation work as separate from routine socket preparation

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 59 Distinct service 62 Co-surgeons 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 6 cited references ↓

CPT 27228 covers the most technically demanding acetabular fracture repairs — specifically open treatment of two-column fractures (including T-fractures and both-column fractures with complete articular detachment), as well as single-column or transverse fractures with an associated acetabular wall component, all requiring internal fixation. This is the highest-complexity code in the acetabular fracture series, above 27226 (posterior or anterior wall only) and 27227 (single column or simple transverse). If the operative note documents hardware placement across two fracture planes of the acetabulum, 27228 is the appropriate code — not 27227.

The 90-day global period is critical here. All routine post-op visits through day 90 are bundled. If a complication requiring a return to the OR arises within that window and the procedure is related to the original repair, bill the return with modifier 78. If unrelated, use modifier 79. New problems addressed during a post-op E/M need modifier 24 on the office visit.

When 27228 is billed alongside a total hip arthroplasty (27130), payers apply CCI bundling logic — management of an acetabular fracture is bundled into 27130 unless hardware placement is separately documented and clinically distinct. The operative report must clearly establish that the acetabular fracture work went beyond what is inherent to the arthroplasty approach.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	28.6
Practice expense RVU	15.76
Malpractice RVU	6.11
Total RVU	50.47
Medicare national rate	$1,685.74
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	$1,685.74
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,321.13

Common denial reasons

The recurring reasons claims for CPT 27228 get rejected.

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

Fracture pattern insufficiently documented — payer downcodes to 27227 when two-column involvement is not explicitly stated in the operative note
CCI bundling denial when billed same-day as 27130 without documentation establishing distinct, separately identifiable fracture fixation beyond arthroplasty
Missing or inadequate pre-op imaging reference in the operative report, causing medical necessity denials
Global period violation — routine post-op E/M visits billed without modifier 24 within the 90-day global window
Incorrect modifier 79 used for a related return-to-OR procedure instead of modifier 78, triggering denial or audit flag

Frequently asked questions

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

01What's the difference between 27227 and 27228?

27227 covers single-column or simple transverse fractures with internal fixation. 27228 requires either two-column involvement (T-fracture, both-column with complete articular detachment) or a single-column/transverse pattern with an associated acetabular wall fracture. The operative note must document which pattern was treated — payers will downcode to 27227 if the distinction isn't explicit.

02Can 27228 and 27130 be billed together?

Only if the acetabular fracture fixation is documented as distinct from the arthroplasty work. CCI edits bundle standard acetabular fracture management into 27130. If the surgeon placed separate hardware to address the fracture before or independent of the socket, document that clearly and use modifier 59 or XS. Absent that, expect a bundling denial.

03Does 27228 carry a global period?

Yes — 90-day global. The day before surgery, the surgery date, and all routine post-op care through day 90 are bundled. Unrelated new problems at a post-op visit need modifier 24 on the E/M. A return to the OR for a related complication needs modifier 78; unrelated procedure needs modifier 79.

04When is modifier 22 appropriate for 27228?

When the procedure was substantially more complex than typical — for example, revision of a prior failed fixation, severely comminuted fracture requiring extended OR time, or morbid obesity with documented anatomic difficulty. You need a brief operative note addendum quantifying the additional time or effort, and expect a payer request for records.

05What ICD-10 codes are paired with 27228?

The fracture code should specify the acetabulum (S32.4– series), laterality, and whether the encounter is initial (A), subsequent (D), or sequela (S). Initial surgical repair uses the 'A' encounter designator. Confirm the fracture subtype in the ICD-10 code matches the documented pattern — a mismatch between the diagnosis code and operative documentation is a common audit trigger.

06Where is 27228 typically performed, and does site of service affect reimbursement?

27228 is almost exclusively performed in an inpatient hospital setting given the fracture complexity and typical patient acuity. CMS Physician Fee Schedule 2026 shows different facility payment rates for HOPD versus ASC settings — see the Site of Service comparison table on this page. Surgeon professional fees are paid under the facility rate in either setting.

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 pattern classification (T-type, both-column, single-column with wall), named surgical approach, hardware type and placement, fluoroscopy use, and any bone grafting from the surgeon's dictation — the exact elements auditors check when a payer questions whether 27228 was justified over 27227. Incomplete fracture pattern documentation is the top reason this code gets downcoded on review.

See how Mira captures CPT 27228 documentation