Closed treatment of an intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture without manipulation — used for stable, nondisplaced fractures managed non-surgically.

Verified May 8, 2026 · 6 sources ↓

Medicare: $457.59
Work RVU: 5.61
Global, days: 90
Region: Hip

Drawn from CMSAAPCFindacodeCodingintelMdclarity

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 intertrochanteric, peritrochanteric, or subtrochanteric — not just 'proximal femur' or 'hip fracture'
Explicit statement that no manipulation was performed and fracture is nondisplaced or stable
Imaging (X-ray or CT) confirming fracture pattern and alignment, referenced in the note
Laterality documented (left or right) to support LT/RT modifier
Treatment plan and immobilization method documented (cast, brace, traction, protected weight-bearing instructions)
ICD-10 fracture code with appropriate 7th character reflecting initial encounter (A) for active fracture care

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

27238 covers closed (non-operative) treatment of femoral fractures occurring at the intertrochanteric, peritrochanteric, or subtrochanteric level, without fracture manipulation. The fracture is stable and nondisplaced; the physician manages it without attempting to reposition bone fragments. This is the correct code when no manipulation is performed — if manipulation is required, a different code in the 27230–27248 range applies.

The 90-day global period means all routine follow-up, cast checks, and fracture management visits through day 90 are bundled. Any visit for an unrelated condition in that window requires modifier 24. A staged or planned additional procedure during the global period uses modifier 58; an unplanned return for a related procedure uses modifier 78.

Side-specific modifiers LT and RT are expected by most payers. Bilateral femoral fractures at this level are rare but theoretically billable with modifier 50. When billing alongside other same-session procedures, apply modifier 51 on the lower-value code and verify NCCI edits before submission.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (5.61) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (13.7) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.61
Practice expense RVU	6.88
Malpractice RVU	1.21
Total RVU	13.7
Medicare national rate	$457.59
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	$457.59
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 27238 get rejected.

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

Fracture location vague — 'hip fracture' without specifying intertrochanteric, peritrochanteric, or subtrochanteric level
ICD-10 7th character mismatch — subsequent encounter (D) used when initial fracture care is being billed
Missing laterality modifier — many payers auto-deny without LT or RT
Services billed during the 90-day global period without modifier 24 for unrelated E/M visits
Code selected when manipulation was actually performed — wrong code in the series applied

Frequently asked questions

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

01What is the difference between 27238 and 27230?

27230 covers closed treatment of a femoral neck fracture without manipulation. 27238 is specifically for fractures at the intertrochanteric, peritrochanteric, or subtrochanteric level without manipulation. Location determines the code — not the treatment method.

02When does 27238 apply instead of 27240?

27240 is used when closed treatment of an intertrochanteric or subtrochanteric fracture includes manipulation of the fracture fragments. 27238 applies only when the fracture is stable and nondisplaced — no manipulation performed.

03Does the 90-day global cover physical therapy visits?

No. PT billed under a separate provider NPI is not bundled into the surgical global. The 90-day global applies to the operating surgeon's own follow-up services related to the fracture.

04What ICD-10 codes pair with 27238?

Use S72.1xx codes (intertrochanteric fracture) or S72.2xx codes (subtrochanteric fracture) with the appropriate 7th character. Use 'A' for initial active fracture care — not 'D', which signals routine follow-up and will trigger a denial for the fracture care code itself.

05Can 27238 be billed if the patient later needs surgical fixation?

Yes. If the fracture initially qualifies for closed treatment without manipulation and later requires surgical intervention, bill the surgical code for that encounter. Use modifier 58 if the same surgeon performs the subsequent procedure during the 90-day global period — this signals a staged or related service.

06Is modifier 50 realistic for bilateral billing with 27238?

Bilateral intertrochanteric or subtrochanteric fractures are clinically uncommon but not impossible — typically seen in high-energy trauma. If genuinely bilateral and both sides are treated at the same encounter, modifier 50 is appropriate. Expect scrutiny; document both sides clearly in imaging reports and the operative/treatment note.

Sources & references

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

Mira Scribe

Mira's AI scribe captures fracture location (intertrochanteric, peritrochanteric, or subtrochanteric), displacement status, explicit documentation that no manipulation was performed, laterality, immobilization method, and weight-bearing instructions directly from dictation. This prevents the two most common denial triggers: vague anatomic location and missing documentation that closed treatment without manipulation — not an open or manipulative procedure — was the appropriate intervention.

See how Mira captures CPT 27238 documentation