Closed treatment of a femoral neck fracture — the proximal end of the femur — with manual manipulation of bone fragments, with or without skeletal traction to maintain alignment during healing.

Verified May 8, 2026 · 6 sources ↓

Medicare: $696.74
Total RVUs: 20.86
Global, days: 90
Region: Hip

Drawn from CMSNIHAAPCFindacode

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify fracture location as proximal femur, neck — not intertrochanteric, subtrochanteric, or shaft
Document that treatment was closed (no incision) and that manipulation was performed
Note whether skeletal traction was applied, including pin placement site and traction weight/device used
Record pre- and post-manipulation imaging (X-ray or fluoroscopy) confirming fracture alignment
Document anesthesia type (general, regional, or conscious sedation) used during manipulation
Record neurovascular status of the extremity before and after manipulation

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 57 Decision for surgery 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 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 27232 covers closed (non-operative) realignment of a femoral neck fracture. The surgeon manipulates the fractured proximal femur to restore alignment without making a surgical incision. If reduction cannot be maintained by positioning alone, skeletal traction using pins or hardware may be added to hold the bone fragments in place while healing progresses. Imaging — typically fluoroscopy or post-reduction X-ray — confirms acceptable reduction before the patient leaves the treatment setting.

This code sits within the 27230–27236 family, all of which address proximal femoral neck fractures. Use 27230 when no manipulation is performed, 27232 when manipulation is performed (with or without skeletal traction), 27235 for percutaneous skeletal fixation, and 27236 for open treatment with internal fixation or prosthetic replacement. Do not apply 27232 to intertrochanteric, peritrochanteric, or subtrochanteric fractures — those map to the 27238–27245 series.

The 90-day global period means all routine follow-up visits, fracture checks, traction adjustments directly related to the femoral neck fracture, and removal of traction hardware are bundled through day 90. Bill unrelated E/M services in that window with modifier 24. A staged or escalating intervention — such as converting to open fixation — requires modifier 58.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	11.43
Practice expense RVU	6.92
Malpractice RVU	2.51
Total RVU	20.86
Medicare national rate	$696.74
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	$696.74
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI G2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 27232 get rejected.

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

Fracture site mismatch — ICD-10 coded to intertrochanteric or subtrochanteric location instead of femoral neck
Upcoded or downcoded: 27232 billed when no manipulation was performed (should be 27230) or when open fixation was done (should be 27236)
Global period conflict — follow-up E/M billed without modifier 24 during the 90-day post-op window
Missing or insufficient post-reduction imaging documentation to support manipulation claim
Place of service mismatch between claim and operative or procedure note

Frequently asked questions

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

01What is the difference between 27230 and 27232?

Both cover closed treatment of a femoral neck fracture. 27230 is used when no manipulation is performed — the fracture is acceptably aligned without adjustment. 27232 requires documented manipulation of the fracture fragments, with or without skeletal traction.

02Can 27232 be used for an intertrochanteric hip fracture?

No. 27232 is specific to the femoral neck (proximal end). Intertrochanteric, peritrochanteric, and subtrochanteric fractures map to 27238 (without manipulation) or 27240 (with manipulation or traction). Using 27232 for those fracture patterns is a coding error.

03What modifier applies if the surgeon later converts to open fixation during the global period?

Use modifier 58 on the open fixation code (27236). This signals a staged or related procedure in the post-operative period and prevents a global period denial.

04Is skeletal traction separately billable when reported with 27232?

No. Skeletal traction applied as part of the closed treatment is included in 27232 — the code descriptor explicitly says 'with or without skeletal traction.' Do not unbundle traction as a separate line item.

05How long is the global period for 27232, and what does it include?

27232 carries a 90-day global period. Covered services include the day-before preoperative visit, the procedure itself, and all routine fracture follow-up, traction checks, and related dressing or pin-site care through post-op day 90. Unrelated E/M services require modifier 24.

06Can 27232 be billed bilaterally?

Bilateral femoral neck fractures treated closed with manipulation in the same session would use modifier 50. That said, simultaneous bilateral proximal femoral neck fractures are rare — document both fracture sites explicitly if billing 50, and expect scrutiny.

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 location (femoral neck, proximal end), the closed approach, whether manipulation was performed, and whether skeletal traction was applied — pulling these details directly from dictation. That prevents the most common denial pattern on this code: a note that documents a hip fracture without specifying neck versus intertrochanteric anatomy, which sends the claim to manual review or triggers a site-of-fracture mismatch denial.

See how Mira captures CPT 27232 documentation