Closed treatment of a proximal femur fracture involving the femoral head, performed without manipulation

Verified May 8, 2026 · 6 sources ↓

Medicare: $431.21
Work RVU: 5.36
Global, days: 90
Region: Hip

Drawn from CMSFastrvuNIHAAPCMdclarity

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 femoral head, proximal end, with laterality (left or right)
Explicit statement that no manipulation was performed and no incision was made
ICD-10 code with displacement status and laterality matching the clinical note
Treatment rationale — why closed treatment without manipulation was clinically appropriate
Date of injury and mechanism documented to support medical necessity
Imaging (X-ray or CT) referenced in the note confirming fracture diagnosis and character

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 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 LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27267 covers closed treatment of a femoral head fracture — proximal end, no incision, no manipulation. The fracture is managed non-operatively: no reduction is attempted, and no internal fixation is placed. This distinguishes it from 27268 (closed treatment with manipulation) and open reduction codes in the 27200s range. Correct code selection hinges on whether manipulation was performed and documented; billing 27267 when the operative note describes any reduction attempt will draw a mismatch denial.

The 90-day global period runs from the date of service. All routine follow-up visits, dressing changes, and fracture checks during that window are bundled. An E/M billed during the global for a reason unrelated to the fracture requires modifier 24. A same-day E/M that led to the decision to treat requires modifier 57 if the decision for a major surgical procedure was made, or modifier 25 for a significant separately identifiable service tied to a minor procedure. A same-day separate and distinct procedure needs modifier 59 or an X modifier where applicable.

Site of service matters here: facility payments differ substantially between HOPD and ASC settings (see the Site of Service comparison table on this page). Document the fracture type, location, and treatment rationale in the operative or clinical note. ICD-10 specificity — laterality, displacement status, fracture type — must match the procedure code or expect a code-mismatch denial.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (5.36) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (12.91) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.36
Practice expense RVU	6.43
Malpractice RVU	1.12
Total RVU	12.91
Medicare national rate	$431.21
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	$431.21
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI G2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 27267 get rejected.

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

ICD-10 laterality or displacement status mismatched with the CPT code billed
Operative or clinical note documents manipulation, contradicting the without-manipulation designation of 27267
Routine post-op visit billed separately during the 90-day global without modifier 24
Same-day E/M billed without modifier 25 or 57, triggering a global period bundling edit
Missing or vague imaging documentation that fails to confirm femoral head fracture diagnosis

Frequently asked questions

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

01What is the difference between 27267 and 27268?

27267 is closed treatment of a femoral head fracture without manipulation. 27268 is the same fracture treated with manipulation — meaning reduction was attempted. If your note describes any attempt to reposition the fragment, 27268 is the correct code. Billing 27267 when the note documents manipulation is a documentation-code mismatch and will draw a denial or audit.

02Does the 90-day global on 27267 include follow-up X-rays?

Routine imaging ordered to monitor fracture healing during the global period is bundled into the procedure payment. Imaging for a new or unrelated condition can be billed separately. If the fracture develops a complication requiring a new evaluation, use modifier 24 on the E/M to distinguish it from routine post-op follow-up.

03Can I bill an E/M the same day as 27267?

Only if it is significant and separately identifiable from the decision to treat. Append modifier 25 for a minor procedure or modifier 57 if 27267 qualifies as a major surgical procedure in your payer's definition. The E/M and the procedure do not require different diagnoses, but the note must document a distinct service beyond the fracture management decision.

04When would modifier 22 apply to 27267?

Modifier 22 applies when the work is substantially greater than typical — for example, an unusually complex fracture pattern, significant comorbidities requiring extended management time, or extraordinary difficulty in achieving adequate immobilization. Attach a cover letter quantifying the additional time and complexity; payers will not pay modifier 22 without supporting documentation.

05Is 27267 payable in an ASC setting?

Yes. ASC and HOPD facility payments differ — see the Site of Service comparison on this page. The physician's professional fee is the same regardless of setting. Confirm with your specific ASC that 27267 is on the covered procedure list before scheduling.

06What ICD-10 codes pair with 27267?

Codes from the S72.0x range cover femoral head fractures. You need full specificity: laterality (1 = right, 2 = left, 9 = unspecified) and encounter type (A for initial, D for subsequent, S for sequela). Submitting with an unspecified laterality code when the note documents a side is a common, preventable denial 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 fracture location (femoral head, proximal femur), laterality, mechanism of injury, and the explicit absence of manipulation from the provider's dictation. It flags when notes reference any attempted reduction — which would point to 27268 instead — preventing an upcoding audit trigger or a mismatch denial on the manipulation status field.

See how Mira captures CPT 27267 documentation