Fracture care · Hip

27269

Open surgical treatment of a fracture at the proximal femur involving the femoral head, with internal fixation applied when indicated.

Verified May 8, 2026 · 6 sources ↓

Medicare
$1,121.27
Total RVUs
33.57
Global, days
90
Region
Hip
Drawn from CMSAAPCCgsmedicareFindacode

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

  • Fracture classification and location: specify femoral head involvement and Pipkin type if applicable
  • Operative approach by name (e.g., Kocher-Langenbeck, Smith-Petersen, surgical hip dislocation)
  • Description of reduction technique and confirmation of reduction — fluoroscopic or intraoperative imaging findings
  • Internal fixation details: implant type, size, and anatomic placement if fixation was applied
  • Associated injuries documented, including any hip dislocation reduced at the same session
  • Pre-op imaging (CT strongly preferred) confirming fracture pattern and ruling out additional pelvic or acetabular injury
  • Intraoperative findings distinguishing this from femoral neck or intertrochanteric fracture (confirms correct code selection)

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 74 Discontinued post-anesthesia 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27269 covers open reduction of a femoral head fracture — the proximal end of the thigh bone — with internal fixation used at the surgeon's discretion based on fracture pattern and stability. This is a high-acuity procedure distinct from femoral neck or intertrochanteric fracture repairs; the femoral head is the articular component that sits inside the acetabulum, and disruption there carries significant risk of avascular necrosis and post-traumatic arthritis.

The 90-day global period means all routine post-op visits, wound checks, and dressing changes are bundled through day 90. Any service unrelated to the fracture repair during that window requires modifier 24 (E/M) or modifier 79 (unrelated procedure). A return to the OR for a complication directly related to the original fixation — such as hardware failure or wound dehiscence requiring irrigation — uses modifier 78.

Femoral head fractures frequently occur alongside hip dislocations (Pipkin classification). If you're also reducing a traumatic hip dislocation at the same operative session, query whether a separate code is supported or whether the work is captured within 27269. Document every component of the procedure — approach, reduction technique, fixation hardware type and placement, and any associated dislocation — to support the medical record if audited.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU18.42
Practice expense RVU11.26
Malpractice RVU3.89
Total RVU33.57
Medicare national rate$1,121.27
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
$1,121.27
HOPD (APC 5114)
Hospital outpatient department
$7,413.38
ASC (PI J8)
Ambulatory surgical center (freestanding)
$4,682.29

Common denial reasons

The recurring reasons claims for CPT 27269 get rejected.

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

  • Wrong-level coding: 27269 billed when fracture is femoral neck or intertrochanteric rather than femoral head — verify fracture location against pre-op CT/X-ray
  • Missing internal fixation documentation when fixation was performed — operative note must specify implant type and placement, not just 'fixation applied'
  • Global period violations: post-op E/M or minor procedure billed without modifier 24 or 79 within the 90-day window
  • Insufficient fracture classification documentation — payers may deny without imaging-confirmed femoral head involvement in the operative note
  • Upcoding flag when approach complexity is not explicitly documented — audit teams reject notes citing only 'standard surgical approach'

Frequently asked questions

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

01How does 27269 differ from 27236 or 27244?
27269 is specifically for open treatment of femoral head fractures. 27236 covers open treatment of femoral neck fractures with internal fixation. 27244 addresses intertrochanteric fractures treated with intramedullary implants. The fracture location — head, neck, or trochanteric region — drives code selection, not the fixation method alone. Pre-op CT or plain films should confirm which segment is fractured before finalizing the code.
02Is internal fixation required to bill 27269?
No. The code covers open reduction of the femoral head fracture with internal fixation 'when performed.' If the fracture is reduced openly but fixation is not placed due to fracture pattern or bone quality, 27269 remains the correct code. Document the decision not to fix explicitly in the operative note.
03Can I bill separately for a concurrent hip dislocation reduction?
Femoral head fractures often accompany traumatic hip dislocations (Pipkin fracture-dislocations). Whether the dislocation reduction is separately billable depends on NCCI edits for the specific code pair. Run the combination through the NCCI PTP lookup before billing. If the dislocation reduction is integral to gaining access for the fracture repair, it typically is not separately reportable.
04What modifier applies if the patient returns to the OR within the global period for infected hardware?
Use modifier 78 if the return is for a complication directly related to the original fracture repair — for example, hardware infection, wound breakdown at the operative site, or fixation failure. Modifier 78 signals an unplanned return to the OR for a related procedure. Use modifier 79 only if the return procedure is entirely unrelated to the original surgery.
05Does the 90-day global period affect billing for physical therapy or rehab referrals?
The global period affects what the operating surgeon's practice can separately bill, not what physical therapists or other independent providers bill. The surgeon cannot separately bill E/M visits that are routine post-op follow-up. However, if a new problem arises unrelated to the fracture repair, the surgeon can bill with modifier 24 appended to the E/M code.
06When is modifier 22 appropriate for 27269?
Modifier 22 applies when the work substantially exceeds what is typical for the procedure — for example, an extremely comminuted femoral head fracture requiring extended operative time, complex reduction, or management of concurrent acetabular damage. You need documentation of the increased complexity in the operative note plus a cover letter explaining the additional work. Payers will request the record, so the note has to stand on its own.

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/27269
  3. 03
    cms.gov
    https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-faq-library
  4. 04
    cms.gov
    https://www.cms.gov/files/document/medicare-ncci-policy-manual-2024-chapter-4.pdf
  5. 05
    cgsmedicare.com
    https://www.cgsmedicare.com/medicare_dynamic/j15/partb/ptpb/ptp.aspx
  6. 06
    findacode.com
    https://www.findacode.com/cpt/27269-cpt-code.html

Mira AI Scribe

Mira's AI scribe captures the fracture classification, approach by name, reduction method, fluoroscopic confirmation findings, and fixation hardware details directly from the surgeon's dictation. This prevents the most common audit flag for 27269 — an operative note that confirms open reduction but fails to document the specific surgical approach or distinguish femoral head involvement from other proximal femur fracture patterns, which triggers downcoding or additional documentation requests.

See how Mira captures CPT 27269 documentation

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