Closed treatment of a femoral head fracture with manipulation — no incision, reduction achieved manually.
Verified May 8, 2026 · 4 sources ↓
- Medicare
- $516.38
- Total RVUs
- 15.46
- Global, days
- 90
- Region
- Hip
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 4 cited references ↓
- Confirm fracture involves the femoral head specifically, not the femoral neck or intertrochanteric region
- Document that manipulation was performed and describe the technique used to achieve reduction
- Record pre- and post-manipulation alignment or reduction quality, ideally with imaging confirmation
- Note the absence of surgical incision or internal fixation to justify closed treatment coding
- Document the anesthesia type used during manipulation (general, regional, conscious sedation, or local)
- Specify laterality (left or right hip) in the operative or procedure note
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 4 cited references ↓
CPT 27268 covers closed (non-operative) treatment of a femoral head fracture where the physician performs manual manipulation to reduce the fracture. No surgical incision is made and no internal fixation is placed. The 090-day global period begins on the date of service and covers all routine postoperative care through day 90, including follow-up visits, imaging review, and cast or splint management related to the fracture.
The key distinction from 27267 is the presence of manipulation: if the fracture is treated closed without any attempt at reduction, bill 27267. If manipulation is performed to achieve or improve alignment, bill 27268. There is no coding correlation between fracture severity or displacement pattern and treatment type — the code selection is driven entirely by what the physician actually did.
If satisfactory alignment cannot be maintained after manipulation and a re-reduction is required by the same physician, append modifier 76 to 27268 for the repeat attempt. If the fracture ultimately requires open treatment within the global period, that becomes a new procedure under modifier 78 (unplanned return to OR for a related procedure).
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 6.94 |
| Practice expense RVU | 7.05 |
| Malpractice RVU | 1.47 |
| Total RVU | 15.46 |
| Medicare national rate | $516.38 |
| 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 | $516.38 |
HOPD (APC 5112) Hospital outpatient department | $1,642.82 |
ASC (PI G2) Ambulatory surgical center (freestanding) | $872.87 |
Common denial reasons
The recurring reasons claims for CPT 27268 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Upcoding flags when documentation describes closed treatment without manipulation — that is 27267, not 27268
- Missing laterality on the claim — append LT or RT to avoid Medicare processing errors
- Unbundling of local anesthesia administration — injection of local anesthetic for manipulation is not separately billable
- Same-day E/M billed without modifier 25 when the decision for manipulation was made at that visit
- Radiologic guidance billed separately when imaging is considered integral to closed fracture management
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 4 cited references ↓
01What is the difference between 27267 and 27268?
02Does 27268 include imaging guidance?
03Can I bill an E/M the same day as 27268?
04What modifier do I use if the same patient needs a repeat manipulation?
05If open treatment becomes necessary within the 90-day global, how do I bill it?
06Is 27268 appropriate for femoral neck or intertrochanteric fractures?
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 specific fracture location (femoral head), the manipulation technique and number of attempts, pre- and post-reduction alignment assessment, anesthesia method, and laterality — all from dictation. This prevents the most common denial trigger for 27268: documentation that describes positioning or immobilization without explicitly confirming that a manual reduction was performed.
See how Mira captures CPT 27268 documentation