Percutaneous skeletal fixation of a proximal femur fracture (femoral neck), performed with in situ pinning rather than open reduction.

Verified May 8, 2026 · 7 sources ↓

Medicare: $836.36
Total RVUs: 25.04
Global, days: 90
Region: Hip

Drawn from CMSBedrockbillingMdclarityAbosPayerprice

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Fracture classification and displacement status (e.g., Garden classification or non-displaced vs. displaced) to support selection of 27235 over open reduction code 27236
Operative note must explicitly state percutaneous approach and confirm no open arthrotomy was performed
Fluoroscopic guidance used during pin or screw placement — note the number of fixation devices, their size, and final position on imaging
Laterality (left vs. right femoral neck) documented in the operative report and on the claim
Surgeon's confirmation that fracture reduction was achieved in situ without formal open reduction maneuver

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 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 7 cited references ↓

CPT 27235 covers percutaneous skeletal fixation of a femoral neck fracture — a closed reduction technique where fluoroscopically guided pins or cannulated screws are placed through small skin incisions to stabilize the fracture in its current position without formal open exposure. It sits in the pelvis and hip joint fracture section and is used primarily for non-displaced or minimally displaced femoral neck fractures where the anatomy is acceptable and open reduction is not required.

27235 carries a 90-day global period. That means the operative day, the day-before visit if applicable, and all routine post-op care through day 90 are bundled — no separate billing for standard follow-up wound checks, stitch removal, or routine fracture monitoring during that window. Services unrelated to the fracture or its fixation require modifier 24 (E/M) or modifier 79 (unrelated surgical procedure) to be separately reimbursed.

This code is commonly performed in the inpatient or on-campus outpatient hospital setting. Laterality modifiers LT and RT are expected when applicable. If the fracture is bilateral — rare but possible in pathologic or high-energy cases — modifier 50 applies. Assistant surgeon billing is recognized under modifier 80 or AS for PA/NP first assist.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	12.68
Practice expense RVU	9.72
Malpractice RVU	2.64
Total RVU	25.04
Medicare national rate	$836.36
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	$836.36
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI G2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 27235 get rejected.

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

Upcoding flag when 27236 (open treatment) documentation language appears in a 27235 claim — any reference to 'open exposure' or 'arthrotomy' triggers review
Missing laterality modifier (LT/RT) causing claim suspension or denial by payers who require it for hip procedures
Routine post-op E/M visits billed separately within the 90-day global period without modifier 24 to indicate an unrelated condition
Bundling denial when fluoroscopic guidance is billed separately — imaging guidance integral to percutaneous fixation is not separately reportable under NCCI policy
ICD-10 diagnosis mismatch — femoral shaft fracture codes paired with 27235, which is specific to the proximal femur/neck, prompt automated denial

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What distinguishes 27235 from 27236?

27235 is percutaneous fixation — pins or screws placed through small stab incisions without opening the hip joint. 27236 is open treatment with internal fixation or prosthetic replacement. If your operative note describes formal exposure of the femoral neck or joint arthrotomy, 27235 is the wrong code.

02Is fluoroscopic guidance separately billable with 27235?

No. Fluoroscopic guidance used to place percutaneous fixation is integral to 27235 under NCCI policy and is not separately reportable. Billing a radiology guidance code alongside 27235 at the same encounter will be bundled.

03Can an assistant surgeon bill with 27235?

Yes. CMS recognizes assistant surgeon participation for 27235. Bill modifier 80 for a physician assistant surgeon or modifier AS when a PA or NP serves as the first assist. Confirm the operative note documents the assistant's participation.

04How does the 90-day global period affect post-op billing?

All routine follow-up related to the femoral neck fracture and its fixation is bundled through day 90. Append modifier 24 to any E/M visit for an unrelated condition during that window, or modifier 79 for an unrelated surgical procedure. Returning to the OR for a complication directly related to the fixation uses modifier 78.

05When is modifier 22 appropriate for 27235?

Modifier 22 applies when the work substantially exceeds a typical femoral neck percutaneous fixation — for example, severe osteoporosis requiring additional fixation constructs, or unusual patient positioning challenges. Attach an operative note summary and a cover letter quantifying the added work. Without documentation, payers routinely reject modifier 22 requests.

06What ICD-10 diagnosis codes pair correctly with 27235?

Codes from the S72.0xx category (femoral neck fracture) are the appropriate match. Using femoral shaft fracture codes (S72.3xx) or intertrochanteric fracture codes (S72.1xx) with 27235 generates an automated mismatch denial — those fractures map to different CPT codes.

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 site (femoral neck vs. shaft), displacement classification, percutaneous approach confirmation, number and type of fixation devices placed, and fluoroscopic guidance use from the surgeon's dictation. That prevents the most common audit flag — operative notes that omit explicit confirmation of the percutaneous technique, which reviewers use to challenge 27235 versus 27236 selection.

See how Mira captures CPT 27235 documentation