Closed treatment of an intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture with manipulation, with or without skin or skeletal traction applied.

Verified May 8, 2026 · 6 sources ↓

Medicare: $898.15
Total RVUs: 26.89
Global, days: 90
Region: Hip

Drawn from CMSAAPCNIH

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Explicit fracture location — intertrochanteric, peritrochanteric, or subtrochanteric — documented in the operative or procedure note; 'proximal femur' alone is insufficient.
Description of the manipulation performed, including technique and confirmation of reduction attempt; absence of manipulation documentation makes 27238 the correct code.
Whether skin traction, skeletal traction, or no traction was applied and the method used.
Pre- and post-reduction imaging (fluoroscopy or X-ray) confirming fracture position after closed reduction.
ICD-10-CM code that specifies fracture type (displaced vs. nondisplaced), laterality (LT/RT), and encounter type (initial vs. subsequent).
Documentation confirming no internal fixation device was placed; if a plate, screw, or IM nail was used, a higher-level code applies.

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 LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

27240 covers closed (non-operative) management of femoral fractures located at or around the trochanters — intertrochanteric, peritrochanteric, or subtrochanteric — where the surgeon manually manipulates the fracture fragments into alignment. Skin or skeletal traction may or may not be applied as part of the treatment. No incision is made and no implant is placed; if internal fixation (plate, screw, or intramedullary nail) is used, step up to 27244 or 27245 instead.

The code sits in a tightly differentiated family: 27238 is the without-manipulation version; 27240 requires documented manipulation. That single distinction drives the code choice — operative notes that omit or vaguely describe the reduction attempt are the primary audit and denial trigger. Fracture location must also be explicit: proximal femoral neck fractures belong in the 27230–27236 range, not here.

27240 carries a 90-day global period. Routine post-fracture follow-up, traction adjustments, and cast or splint checks within that window are bundled. Unrelated conditions billed during the global require modifier 24; a new injury or unrelated procedure requires modifier 79.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	13.46
Practice expense RVU	10.5
Malpractice RVU	2.93
Total RVU	26.89
Medicare national rate	$898.15
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	$898.15
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 27240 get rejected.

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

Code billed as 27240 when the operative note describes internal fixation — should be 27244 (plate/screw) or 27245 (IM nail); payers downcode or deny outright.
Manipulation not documented — payer defaults to 27238 (without manipulation) and adjusts payment accordingly.
Fracture site documented as femoral neck rather than intertrochanteric/peritrochanteric/subtrochanteric — wrong code family; should be 27230–27236.
ICD-10-CM code missing laterality or encounter type, triggering a claim-level edit before the code is even adjudicated.
Routine post-fracture office visits billed separately within the 90-day global period without modifier 24, causing bundling denials.

Frequently asked questions

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

01What separates 27240 from 27238?

Manipulation. 27238 is closed treatment without any reduction attempt. 27240 requires documented manual manipulation of the fracture fragments. If your note doesn't describe the reduction, the payer will pay at the 27238 level.

02When should I use 27244 or 27245 instead of 27240?

Any time an implant is placed. 27244 covers plate/screw fixation with or without cerclage; 27245 covers intramedullary nail fixation. 27240 is strictly closed treatment — no incision, no hardware.

03Can I bill a separate E/M on the same day as 27240?

Only if the E/M addresses a problem entirely unrelated to the fracture. Append modifier 25 to the E/M and document the separate medical decision-making. A pre-op evaluation for the same fracture is bundled.

04Does the 90-day global include traction management?

Yes. Routine traction adjustments, follow-up visits related to the fracture, and cast or splint checks are all bundled into the global. Bill separately only for unrelated conditions (modifier 24) or complications requiring a return to the OR (modifier 78 for related, 79 for unrelated).

05Is 27240 appropriate for bilateral fractures, and how do I bill it?

Bilateral intertrochanteric fractures are rare but possible in high-energy trauma. Append modifier 50 for bilateral same-session treatment, or use LT and RT on separate line items per payer preference — confirm with the individual payer before submitting.

06Which ICD-10-CM codes pair with 27240?

Use codes from the S72 category, specifying intertrochanteric (S72.1x), peritrochanteric (S72.13x–S72.14x), or subtrochanteric (S72.2x) fracture with correct laterality and displaced/nondisplaced status. Initial encounter uses the 'A' suffix; subsequent encounter uses 'D'. Mismatched encounter suffixes are a common edit trigger.

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's exact anatomical zone (intertrochanteric, peritrochanteric, or subtrochanteric), the surgeon's manipulation technique and reduction confirmation, traction type if applied, and the absence of any implant placement — all from dictation. That specificity prevents the two most common denials: upcoding challenges when fixation details are ambiguous, and automatic downcoding to 27238 when manipulation language is missing from the note.

See how Mira captures CPT 27240 documentation