Open surgical repair of a greater trochanteric fracture at the proximal femur, with internal fixation (pins, screws, or other implants) when performed.

Verified May 8, 2026 · 7 sources ↓

Medicare: $685.72
Total RVUs: 20.53
Global, days: 90
Region: Hip

Drawn from CMSAAPCAAOS

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Operative note must specify that an open (not closed or percutaneous) approach was used to access the fracture site
Document exact implants placed — screw type, size, and count — or explicitly state no internal fixation was used if applicable
Imaging (intraoperative fluoroscopy or post-reduction X-ray) confirming fracture reduction and hardware position must be referenced or included
Fracture characterization in the pre-op note or H&P: acuity (acute vs. nonunion), mechanism, and which trochanter is involved (greater vs. lesser)
If modifier 22 is appended, the operative note must quantify why the work substantially exceeded typical — e.g., comminution, prior hardware, failed prior repair, or severe osteoporosis complicating fixation
Laterality documented: left or right greater trochanter, to support LT or RT modifier on the claim

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 51 Multiple procedures 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 73 Discontinued pre-anesthesia 74 Discontinued post-anesthesia 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 27248 covers open treatment of a fracture at the greater trochanter of the femur, the bony prominence at the top of the thigh bone where several hip abductor muscles attach. The procedure requires a surgical incision to directly visualize the fracture site; internal fixation with screws, pins, or similar hardware is included when used and is not reported separately. This distinguishes 27248 from closed or percutaneous approaches to proximal femur fractures reported under other codes in the 272xx family.

The 90-day global period applies. All routine post-op care — wound checks, hardware monitoring visits, and dressing changes — is bundled through day 90. Any unrelated E/M service during that window needs modifier 24. If the decision for surgery was made the day of or day before the procedure at a separately identifiable E/M visit, append modifier 57 to that E/M code.

Billing 27248 alongside a hemiarthroplasty (e.g., 27125) on the same encounter is a known Medicare denial trigger — payers consider the trochanteric fixation bundled into the arthroplasty work. If fixation of the greater trochanter was a distinct, separately documented surgical challenge during an arthroplasty, modifier 22 on the arthroplasty code with detailed operative note documentation is the appropriate path, not unbundling with 27248.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.51
Practice expense RVU	7.81
Malpractice RVU	2.21
Total RVU	20.53
Medicare national rate	$685.72
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	$685.72
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI G2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 27248 get rejected.

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

Unbundling denial when 27248 is billed on the same date as a hemiarthroplasty (27125) — Medicare and most payers consider trochanteric fixation included in the arthroplasty
Incorrect code selection: coders confuse greater trochanteric fracture (27248) with intertrochanteric or subtrochanteric fractures, which map to 27244 or 27245
Missing or insufficient operative note — claims without documentation of open exposure and fixation detail are flagged by pre-payment edits and post-payment audits
Global period conflict — post-op visits billed without modifier 24 or 79 when 27248 is the index procedure
Laterality omission — claims without LT or RT modifier rejected by payers requiring bilateral designation on musculoskeletal surgical codes

Frequently asked questions

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

01Is internal fixation separately billable when performed with 27248?

No. Internal fixation is included in 27248 when performed. Billing a separate hardware or fixation code alongside 27248 for the same fracture is incorrect and will deny.

02Can I bill 27248 with a hemiarthroplasty on the same date?

Medicare denies 27248 as inclusive to hemiarthroplasty (27125). If the greater trochanteric fixation represented substantially increased work, use modifier 22 on the arthroplasty code with detailed documentation — do not unbundle 27248 as a separate line.

03What is the correct code if the fracture is intertrochanteric rather than at the greater trochanter?

Intertrochanteric fractures treated with a plate/screw construct report under 27244; those treated with an intramedullary implant report under 27245. CPT 27248 is specific to isolated greater trochanteric fractures only.

04How should a greater trochanteric nonunion repair be coded?

27248 covers both acute fractures and nonunions of the greater trochanter treated with open fixation. Document the nonunion diagnosis explicitly with the appropriate ICD-10 nonunion code (M84.35x series) to avoid medical necessity denial.

05Does the 90-day global period reset if the patient needs a return to the OR?

A planned staged procedure by the same surgeon resets the global with modifier 58. An unplanned return for a related complication (e.g., hardware failure) uses modifier 78 — the global does not reset, and reimbursement is reduced. An unrelated procedure in the global window uses modifier 79.

06When is modifier 22 appropriate for 27248?

Use modifier 22 when operative complexity substantially exceeded the typical case — severe comminution, prior failed fixation with retained hardware removal, or extreme osteoporosis requiring augmented technique. The operative note must describe and quantify that additional work explicitly; a vague reference to 'difficult case' will not survive audit.

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 surgical approach (open incision with direct fracture visualization), implant details (screw type, size, count), intraoperative imaging confirmation, and explicit laterality from dictation. It flags when the note lacks a clear distinction between open and percutaneous technique — the single most common reason 27248 claims are downcoded or denied on audit. If the surgeon dictates concurrent arthroplasty work, the scribe surfaces the bundling risk before the claim is built.

See how Mira captures CPT 27248 documentation