Open treatment of a proximal femoral fracture at the femoral neck, using internal fixation hardware or prosthetic replacement to stabilize the fracture site.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,089.87
Total RVUs: 32.63
Global, days: 90
Region: Hip

Drawn from CMSAAPCMdclarityAAOSFindacode

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Confirm fracture location as femoral neck, not intertrochanteric or subtrochanteric — site determines the correct code.
Specify fixation method: cannulated screws, sliding hip screw, or prosthetic replacement (hemiarthroplasty).
Document the surgical approach by name (e.g., Watson-Jones, posterior/Kocher-Langenbeck) — audit teams flag notes that say only 'standard approach'.
Record fluoroscopic confirmation of reduction and hardware placement intraoperatively.
Document neurovascular status and weight-bearing instructions for post-op global period tracking.
Note any complicating factors (comminution, osteoporosis, prior hardware, prior arthroplasty) that support modifier 22 if used.

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 25 Significant separate E/M 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 62 Co-surgeons 73 Discontinued pre-anesthesia 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

Related ICD-10 diagnoses

Diagnoses commonly reported with CPT 27236.

Source · CMS LCDs · AAOS specialty guidance · claims-pattern analysis

S72.001A S72.002A S72.009A S72.011A

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

27236 covers open reduction and internal fixation (ORIF) of a femoral neck fracture — the surgeon directly exposes the fracture, reduces it, and stabilizes it with screws, a sliding hip screw, or a prosthetic replacement. This is not the code for intertrochanteric fractures fixed with an intramedullary nail; that's 27245. The fracture location (femoral neck) and fixation method (open, internal fixation or prosthesis) are both required to justify 27236.

The 90-day global period is the dominant billing consideration here. It covers the day-of and day-before surgery visits, plus all routine post-op management through day 90. Any E/M service during that window for an unrelated condition requires modifier 24. If the decision for surgery was made at a separately identifiable visit on the day of or day before surgery, append modifier 57 to that E/M — 27236 is a major procedure (90-day global), so modifier 57 applies.

Site of service matters significantly for this code. HOPD and ASC payment rates differ substantially; see the site-of-service comparison table. When a staged return to the OR is planned — for example, a planned hardware exchange — bill the subsequent procedure with modifier 58 to reset the global period. An unplanned return to address a related complication (e.g., hardware failure) uses modifier 78, not 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	17.17
Practice expense RVU	11.85
Malpractice RVU	3.61
Total RVU	32.63
Medicare national rate	$1,089.87
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	$1,089.87
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,881.55

Common denial reasons

The recurring reasons claims for CPT 27236 get rejected.

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

Wrong code selected: 27236 billed when an intramedullary nail was used for an intertrochanteric fracture — correct code is 27245.
E/M billed during 90-day global period without modifier 24 or 25, triggering automatic bundling denial.
Modifier 57 missing on a same-day or day-before decision-for-surgery E/M visit billed alongside a 90-day global procedure.
Laterality not specified (LT/RT missing) when payer requires it for bilateral-capable procedures.
Modifier 78 and 58 confused: unplanned return for hardware complication billed with 58 instead of 78, or vice versa.

Frequently asked questions

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

01What is the difference between 27236 and 27245?

27236 is for open treatment of a femoral neck fracture with internal fixation or prosthetic replacement. 27245 is for fixation of an intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture — typically with an intramedullary nail. Fracture location in the operative note drives the code selection; if the surgeon used an IM nail on an intertrochanteric fracture, 27245 is correct regardless of what was submitted initially.

02Does the 90-day global period apply to 27236?

Yes. The 90-day global covers the day-before visit, the surgery, and all routine post-op management through day 90. E/M visits for unrelated conditions during that window need modifier 24. The decision-for-surgery visit on the day of or day before surgery needs modifier 57 on the E/M to be separately payable.

03When should modifier 22 be used with 27236?

Append modifier 22 when operative work is substantially greater than typical — for example, severely comminuted osteoporotic fracture, prior failed fixation hardware requiring removal, or morbid obesity significantly increasing operative time and complexity. Documentation must quantify the additional work; a generic note that says 'difficult case' will not support reimbursement.

04Can a hemiarthroplasty be billed under 27236?

Yes. When a femoral neck fracture is treated with prosthetic replacement (hemiarthroplasty) rather than internal fixation, 27236 still applies. Document the implant type and rationale for prosthetic choice (e.g., displaced femoral neck fracture in an elderly patient where fixation failure risk is high).

05How do I bill a return to the OR for hardware failure during the global period?

Use modifier 78 for an unplanned return to the OR for a complication related to the original procedure — such as hardware cutout or avascular necrosis requiring revision. Use modifier 58 only if the staged return was anticipated and documented at the time of the index surgery. Inverting these modifiers is a frequent audit finding.

06Is fluoroscopy separately billable with 27236?

No. Intraoperative fluoroscopy used to confirm reduction and hardware placement during open fracture fixation is integral to the procedure and bundled into 27236. Billing a separate fluoroscopy code for guidance used in the same operative field will be denied under NCCI bundling rules.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures fracture location (femoral neck vs. intertrochanteric), fixation method (cannulated screws, sliding hip screw, prosthetic replacement), surgical approach by name, and fluoroscopic confirmation of reduction — all from dictation. This prevents the most common audit flag for 27236: an operative note that doesn't distinguish femoral neck from trochanteric anatomy, which is the primary driver of 27236-vs-27245 miscoding denials.

See how Mira captures CPT 27236 documentation