Closed treatment of a greater trochanteric fracture without any reduction or repositioning of the bone fragments.

Verified May 8, 2026 · 6 sources ↓

Medicare: $427.87
Total RVUs: 12.81
Global, days: 90
Region: Hip

Drawn from CMSAAPCEmednyCgsmedicareGenhealth

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Imaging (X-ray or CT) confirming greater trochanteric fracture with fracture location and displacement status documented
Explicit statement that no manipulation or reduction was performed
Immobilization method specified (brace type, splint, or weight-bearing restriction protocol)
Laterality documented — left or right hip — to support LT/RT modifier use
Pain management approach and functional status at time of treatment noted
Plan for follow-up imaging and weight-bearing progression outlined in the note

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 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 ↓

CPT 27246 covers non-operative management of a greater trochanter fracture — the bony prominence at the proximal lateral femur — where no manipulation of the fracture fragments is performed. Treatment consists of immobilization (brace, splint, or protected weight-bearing protocol), pain management, and scheduled follow-up imaging to confirm alignment and healing progression. No incision, fixation hardware, or fracture reduction is involved.

This code sits within the hip fracture family alongside 27240 (femoral neck, without manipulation), 27244 (intertrochanteric with plate/screw), and 27248 (open treatment of greater trochanteric fracture with internal fixation). Selecting 27246 over 27248 hinges entirely on whether the case remained closed and required no operative fixation — document that decision explicitly. If intraoperative findings force a switch to open fixation, 27248 is the correct code regardless of what was planned.

The 90-day global period applies. All routine post-fracture follow-up visits, imaging ordered to monitor healing, and dressing changes through day 90 are bundled. Unrelated E/M services in that window require modifier 24. A new fracture complication managed surgically during the global period — such as avulsion nonunion requiring fixation — bills with modifier 78 if related or 79 if unrelated.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	4.71
Practice expense RVU	7.09
Malpractice RVU	1.01
Total RVU	12.81
Medicare national rate	$427.87
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	$427.87
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI A2) Ambulatory surgical center (freestanding)	$135.54

Common denial reasons

The recurring reasons claims for CPT 27246 get rejected.

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

Missing laterality — payers routinely reject hip fracture claims without LT or RT modifier
ICD-10 diagnosis code does not map to greater trochanter specificity (S72.1xx series required, not generic femur fracture codes)
Procedure upcoded to 27248 without documentation supporting open treatment or internal fixation
Global period violation — post-op follow-up E/M billed without modifier 24 during the 90-day window
Insufficient imaging documentation — no radiology report or in-office X-ray finding referenced to confirm fracture diagnosis

Frequently asked questions

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

01What distinguishes 27246 from 27248?

27246 is closed treatment — no incision, no hardware, no manipulation. 27248 is open treatment with internal fixation. If the patient goes to the OR and fixation is placed, 27248 is correct regardless of original intent.

02Do I need LT or RT modifier on every claim?

Yes for Medicare and most commercial payers. Hip fracture codes are site-specific; claims without laterality modifiers routinely reject. Bill LT or RT on the same line. For ASC bilateral (rare for this injury), use separate claim lines with LT and RT.

03What ICD-10 codes support 27246?

Use the S72.1xx series — greater trochanter fracture codes — with the appropriate 7th character for initial encounter (A), subsequent encounter (D), or sequela (S). Generic proximal femur codes are a common audit flag.

04Can I bill an E/M on the same day as 27246?

Only if the E/M is a separately identifiable service unrelated to the fracture decision. Add modifier 25 to the E/M. If the visit is the fracture evaluation that led directly to 27246, the E/M is bundled.

05What happens if I need to return the patient to the OR for fixation during the 90-day global?

If the return is for a complication related to the original fracture (e.g., displacement requiring fixation), bill 27248 with modifier 78. If the second procedure is unrelated, use modifier 79.

06Is this code ever billed bilaterally?

Bilateral greater trochanteric fractures are rare but possible in high-energy trauma. If both sides are treated, add modifier 50 for the professional claim. ASC bills two separate lines with LT and RT per CMS NCCI policy.

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 site (greater trochanter, left or right), displacement status from imaging, the explicit decision not to manipulate, and the immobilization device or weight-bearing restriction ordered. That detail directly prevents the two most common denials: wrong ICD-10 specificity and missing documentation to justify closed-versus-open code selection.

See how Mira captures CPT 27246 documentation