Closed treatment of a proximal femur neck fracture without any manipulation of the fracture fragments.

Verified May 8, 2026 · 6 sources ↓

Medicare: $536.42
Total RVUs: 16.06
Global, days: 90
Region: Hip

Drawn from CMSAAPCAcgmeCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Fracture location specified as femoral neck (proximal end) — not just 'hip fracture'
Explicit confirmation that no manipulation or reduction was performed
Mechanism of injury and imaging findings (X-ray or CT confirming neck fracture)
Fracture displacement status documented (non-displaced vs. impacted)
Treatment plan rationale explaining why closed non-manipulation management was appropriate
Laterality documented (left, right, or bilateral) to support LT/RT or modifier 50 if bilateral

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 58 Staged or related 76 Repeat, same physician 77 Repeat, another physician 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 ↓

CPT 27230 covers closed treatment of a femoral neck fracture — the proximal end of the femur — where no manipulation (reduction) of the fracture is performed. The physician manages the fracture conservatively: no realignment, no open surgery, no percutaneous fixation. This is strictly the without-manipulation variant; if the surgeon reduces the fracture, that's 27232, and any percutaneous pinning moves you to 27235.

Fracture location is the first decision point. Codes 27230–27236 are reserved for the femoral neck (proximal end). If the fracture is intertrochanteric, peritrochanteric, or subtrochanteric, the correct family is 27238–27245. Audit teams look for location-specific documentation; operative and ED notes that say only 'hip fracture' without specifying anatomic zone are a common trigger for downcoding or denial.

27230 carries a 90-day global period. All routine fracture management, office visits, and casting/strapping through day 90 are bundled. Separately billable services within the global window require modifier 24 (unrelated E/M) or modifier 79 (unrelated procedure). Per NCCI policy, if the same cast or splint immobilizes multiple fractures of the same anatomic region, only one closed-treatment code is reportable.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.66
Practice expense RVU	9.18
Malpractice RVU	1.22
Total RVU	16.06
Medicare national rate	$536.42
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	$536.42
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI A2) Ambulatory surgical center (freestanding)	$135.54

Common denial reasons

The recurring reasons claims for CPT 27230 get rejected.

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

Fracture documented as intertrochanteric or subtrochanteric — wrong code family, should be 27238 series
Operative or ED note says 'hip fracture' without specifying femoral neck, triggering medical necessity queries
Manipulation or reduction performed but 27230 billed instead of 27232
Percutaneous pinning performed same encounter — fixation upgrades to 27235, making 27230 a downcoded duplicate
Post-op visit billed within 90-day global without modifier 24 or 79, resulting in bundling denial

Frequently asked questions

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

01What separates 27230 from 27232 and 27235?

27230 is closed treatment without manipulation. 27232 is closed treatment with manipulation (reduction), with or without skeletal traction. 27235 adds percutaneous skeletal fixation (e.g., cannulated screws). If the surgeon touched the fracture to reduce it, 27230 is wrong.

02Can I bill 27230 for an intertrochanteric hip fracture?

No. 27230 is specific to the femoral neck (proximal end). Intertrochanteric, peritrochanteric, and subtrochanteric fractures belong to the 27238–27245 family. Mixing these is a common audit finding.

03What is the global period for 27230 and what does it bundle?

27230 carries a 90-day global period. That includes the day-before visit, the procedure day, and all routine fracture follow-up through day 90 — office visits, splint checks, and casting. Unrelated E/M visits in that window need modifier 24; unrelated procedures need modifier 79.

04Is modifier 50 appropriate if both femoral necks are fractured and treated without manipulation?

Yes. If both femoral necks are treated closed without manipulation at the same session, append modifier 50 to 27230. Also document laterality in the note. Bilateral femoral neck fractures are uncommon; expect payer scrutiny and ensure imaging supports both diagnoses.

05Can I separately bill fluoroscopy used to confirm fracture position during 27230?

Generally no for Medicare. Per NCCI policy, if fluoroscopy is integral to confirming fracture position during the treatment, it is not separately reportable. Check your specific payer's policy — some commercial payers differ.

06If the same cast also immobilizes a second fracture of the same region, can I bill both closed-treatment codes?

No. NCCI policy states that if a single cast, splint, or strapping treats multiple fractures in the same anatomic area without manipulation, only one closed-treatment code is reportable for that anatomic region.

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 anatomic zone (femoral neck vs. intertrochanteric), displacement status, confirmation that no reduction or manipulation was performed, laterality, and the clinical rationale for conservative management — all from dictation. That specificity prevents the two most common 27230 denials: wrong-family coding when location is vague, and upcoding flags when the note implies a reduction was attempted.

See how Mira captures CPT 27230 documentation