Fracture care · Hip

27245

Open treatment of an intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture using an intramedullary implant, with or without interlocking screws and/or cerclage.

Verified May 8, 2026 · 6 sources ↓

Medicare
$1,118.26
Total RVUs
33.48
Global, days
90
Region
Hip
Drawn from CMSAAPCBedrockbillingAAOS

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'
  • Implant type documented by name (e.g., cephalomedullary nail, trochanteric nail) with manufacturer and size
  • Intramedullary approach confirmed; note whether interlocking screws and/or cerclage were used
  • Pre-op imaging (X-ray or CT) referenced in the operative note showing fracture level
  • Patient positioning, surgical approach incision site, and fluoroscopy use documented
  • Anesthesia type and any intraoperative complications or deviations from standard technique noted
  • Post-op hardware integrity confirmed with intraoperative fluoroscopy images retained in record

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 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 62 Co-surgeons 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

Related ICD-10 diagnoses

Diagnoses commonly reported with CPT 27245.

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

S72.101A S72.102A S72.109A S72.141A

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27245 covers open surgical treatment of femoral fractures in the trochanteric region — intertrochanteric, peritrochanteric, or subtrochanteric — stabilized with an intramedullary device inserted into the femoral canal. The surgeon may supplement fixation with interlocking screws that lock through the nail into the proximal or distal femur, and may add cerclage wire or banding to control comminuted fragments. This is the intramedullary nail variant; open reduction with a sliding hip screw or plate construct bills separately under different codes.

The 90-day global period covers the operative session, the day-before decision visit (with modifier 57), and all routine postoperative management through day 90. Wound checks, hardware monitoring visits, and routine imaging within the global window are bundled. Bill modifier 24 on any E/M that addresses a problem genuinely unrelated to the fracture during that window.

Not all femur fractures map to 27245. Diaphyseal (shaft) fractures use a different code family, and femoral neck or head fractures sit in a separate section. Confirm the fracture level in the operative report and the imaging reads before selecting this code — auditors cross-reference the implant used (cephalomedullary nail versus antegrade shaft nail) against the code billed.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU17.73
Practice expense RVU12.04
Malpractice RVU3.71
Total RVU33.48
Medicare national rate$1,118.26
Global period90 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

SettingMedicare rate (national)
Office (PFS non-facility)
Procedure performed in physician's office
$1,118.26
HOPD (APC 5114)
Hospital outpatient department
$7,413.38
ASC (PI J8)
Ambulatory surgical center (freestanding)
$4,831.57

Common denial reasons

The recurring reasons claims for CPT 27245 get rejected.

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

  • Fracture level not specified — 'proximal femur fracture' without intertrochanteric/subtrochanteric qualifier triggers medical necessity review
  • Implant documentation missing or inconsistent with the code billed (e.g., sliding hip screw noted but 27245 billed)
  • Bundling conflict when accessory fixation codes are billed separately without NCCI modifier support
  • Global period violation — postoperative E/M billed without modifier 24 when visit is for the operative diagnosis
  • Modifier 22 appended without supporting documentation of substantially increased operative time or complexity
  • Bilateral modifier 50 applied incorrectly — bilateral intertrochanteric fractures are rare; payers may audit for justification

Frequently asked questions

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

01What's the difference between 27245 and the femoral shaft fracture codes?
27245 is limited to fractures in the trochanteric zone — intertrochanteric, peritrochanteric, and subtrochanteric. Diaphyseal (mid-shaft) femur fractures treated with an IM nail bill under a different code. The operative note and pre-op imaging must confirm the fracture apex sits in the trochanteric region, not the shaft.
02Can 27245 be billed with the E/M visit on the day of surgery?
Only if the E/M represents the decision for surgery and is documented as such. Add modifier 57 to the E/M — 27245 carries a 90-day global, so the day-of or day-before visit is otherwise bundled. Without modifier 57, the E/M claim will deny.
03When is modifier 22 appropriate for this code?
Use modifier 22 when the operative work was substantially greater than typical — documented reasons include severe comminution requiring additional fragment reduction, prior failed fixation hardware requiring removal before nailing, or extreme obesity significantly prolonging the procedure. The operative note must quantify extra time and describe the complicating factors specifically.
04Is cerclage wiring separately billable when performed with 27245?
No. Cerclage used as an adjunct to stabilize fragments during intramedullary nailing is part of the 27245 procedure and is not separately reportable. NCCI bundling policy treats accessory fixation techniques performed at the same fracture site as integral to the primary repair code.
05How does modifier 78 apply if the patient returns to the OR for a fixation failure?
If the return is for a complication directly related to the original fixation — such as hardware failure or loss of reduction — bill the revision procedure with modifier 78. This signals an unplanned return for a related procedure within the 90-day global period. Payment is reduced to the intraoperative component only; the postoperative period does not restart.
06Can 27245 and a hip arthroplasty code be billed together if the fracture is converted to arthroplasty in the same session?
No. If the surgical plan converts to arthroplasty during the same operative session, bill the arthroplasty code that reflects what was actually performed. Billing both the fracture repair and the arthroplasty for the same anatomic site in the same session is a bundling violation. Document the intraoperative decision and the final construct in the operative note.
07What modifier applies when a second surgeon assists and bills separately?
The assisting surgeon bills 27245 with modifier 80 (or AS if a PA or NP). The primary surgeon's claim carries no modifier. Both claims require matching operative date and diagnosis codes, and the operative note should reflect the assistant's participation.

Sources & references

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

  1. 01CMS Physician Fee Schedule 2026
  2. 02
    aapc.com
    https://www.aapc.com/codes/cpt-codes/27245
  3. 03
    bedrockbilling.com
    https://bedrockbilling.com/static/cci/27245
  4. 04
    cms.gov
    https://www.cms.gov/files/document/2026-medicaid-ncci-chapter-4-policy-manual.pdf
  5. 05
    cms.gov
    https://www.cms.gov/files/document/chapter4cptcodes20000-29999final11.pdf
  6. 06
    aaos.org
    https://www.aaos.org/globalassets/quality-and-practice-resources/coding-and-reimbursement/resident-guide/resident-guide_modifiers.pdf

Mira AI Scribe

Mira's AI scribe captures the fracture descriptor (intertrochanteric, peritrochanteric, or subtrochanteric), implant name and size, use of interlocking screws and cerclage, and fluoroscopy confirmation from the surgeon's dictation — the four elements auditors check first when this code is billed. Missing any one of them is the leading reason 27245 claims get kicked for medical necessity review or downcoded to a lesser fracture repair code.

See how Mira captures CPT 27245 documentation

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