Open fixation of an intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture using a plate/screw-type implant, with or without cerclage.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,121.27
Total RVUs: 33.57
Global, days: 90
Region: Hip

Drawn from CMSAAPCFindacodePayerpriceAAOS

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Fracture location documented precisely: intertrochanteric, peritrochanteric, or subtrochanteric — not just 'proximal femur fracture'
Implant type specified as plate/screw construct (e.g., dynamic hip screw, sliding hip screw); intramedullary nail use routes to 27245 instead
Operative report names the surgical approach and confirms open technique, not closed or percutaneous
Cerclage wire use documented if applicable, even though it does not change the code
Laterality (left or right femur) documented and matched to the claim modifier (LT or RT)
Imaging (pre-op X-ray or CT) in the record confirming fracture pattern and supporting the chosen fixation strategy
Any intraoperative fluoroscopy use noted; typically bundled but must be documented to defend against separate billing flags

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 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 7 cited references ↓

CPT 27244 covers surgical stabilization of proximal femur fractures — specifically intertrochanteric, peritrochanteric, or subtrochanteric patterns — using a plate/screw construct such as a dynamic hip screw or sliding hip screw system, with or without cerclage wire. This is an open procedure; if the surgeon uses an intramedullary nail instead, bill 27245. The distinction between implant type is the primary code selector, not fracture displacement or patient age.

The 90-day global period means all routine follow-up, wound checks, and implant monitoring visits through day 90 are bundled. Billing a related E/M in that window requires modifier 24. An unplanned return to the OR for a related complication — hardware failure, wound dehiscence, hematoma — uses modifier 78. A staged or planned secondary procedure (e.g., conversion to arthroplasty after fixation failure) uses modifier 58. Note that 27170 (bone grafting of femoral head) is bundled with 27244; autograft harvested through the same incision cannot be billed separately.

Cast, splint, or strapping application is included in the fracture code per NCCI policy and cannot be reported separately when the operating surgeon assumes follow-up care. Fluoroscopic imaging used intraoperatively is also typically bundled. If a separately identifiable E/M is performed on the same date as the procedure — for example, a new consult in the ED before the decision to operate — append modifier 57 to the E/M.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	17.73
Practice expense RVU	12.09
Malpractice RVU	3.75
Total RVU	33.57
Medicare national rate	$1,121.27
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	$1,121.27
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,784.46

Common denial reasons

The recurring reasons claims for CPT 27244 get rejected.

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

Wrong code selected: 27245 billed when operative report describes a plate/screw system rather than an intramedullary nail, or vice versa
Missing laterality modifier — payers that require LT or RT will deny without it
Related E/M billed within the 90-day global period without modifier 24, triggering automatic bundling denial
Cast or splint application billed separately when the operating surgeon assumed follow-up care, violating NCCI policy
27170 (femoral head bone grafting) billed separately when graft was harvested through the same incision as 27244

Frequently asked questions

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

01What is the difference between 27244 and 27245?

The implant type drives the split. 27244 is for plate/screw constructs (dynamic hip screw, sliding hip screw). 27245 is for intramedullary implants (cephalomedullary nails). Fracture location is the same for both — the operative report must name the device to support whichever code is billed.

02Does 27244 include intraoperative fluoroscopy?

Yes, for the surgeon. Fluoroscopic guidance used intraoperatively during open fracture fixation is bundled into the surgical code per NCCI policy. The facility may have separate reporting rules under OPPS.

03Can I bill 27170 (femoral head bone grafting) alongside 27244?

Only if the graft is harvested through a separate incision. 27170 is bundled with 27244 per AAPC coding guidance. Same-incision autograft cannot be unbundled, even with modifier 59.

04How do I bill for a return to the OR after hardware failure during the global period?

Use modifier 78 if the return is unplanned and the procedure is related to the original fixation (hardware failure, infection at the implant site). Modifier 79 applies only to unrelated procedures performed during the global period. Do not invert these — payers audit modifier 78 vs. 79 usage.

05Is modifier 50 appropriate for bilateral femoral fractures?

Technically possible but rare. Bilateral simultaneous femoral fractures do occur (e.g., high-energy trauma). If both sides are fixed in the same session with plate/screw constructs, append modifier 50 and document both fractures with separate operative descriptions. Expect payer-specific bilateral payment rules to reduce reimbursement on the second side.

06What modifier is needed if a separate E/M is performed the same day as 27244?

Modifier 57 if the E/M represents the decision to perform surgery. Modifier 25 applies to minor procedures with a 000 global, not to 090-global surgeries like 27244. Use 57 on the E/M when the visit resulted in the surgical decision.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures implant type (plate/screw vs. intramedullary), fracture subtype (intertrochanteric, peritrochanteric, or subtrochanteric), laterality, and whether cerclage was used — directly from the surgeon's dictation. That prevents the most common audit flag: an operative note that names the fracture zone generically or fails to distinguish the implant class, which auditors use to challenge 27244 vs. 27245 code selection.

See how Mira captures CPT 27244 documentation