Surgical · Knee

27448

Osteotomy of the femoral shaft or supracondylar region performed without internal or external fixation devices.

Verified May 8, 2026 · 6 sources ↓

Medicare
$762.54
Total RVUs
22.83
Global, days
90
Region
Knee
Drawn from CMSAbosAAPCCgsmedicareFindacode

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

  • Explicit statement in the operative note that no internal or external fixation device was used
  • Identification of the osteotomy site — femoral shaft versus supracondylar region — with anatomic specificity
  • Pre-operative imaging confirming the deformity or malalignment requiring correction
  • Diagnosis supporting medical necessity (e.g., angular deformity, malunion, genu valgum or varum)
  • Description of the surgical approach and technique used to perform the bone cut
  • Post-operative immobilization plan documented when no fixation is applied

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 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

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27448 covers a femoral osteotomy — a deliberate bone cut through the shaft or supracondylar area of the femur — performed without any fixation hardware. The surgeon cuts the bone to correct angular deformity or malalignment, then allows the corrected position to be maintained by casting or other non-hardware means. No plates, screws, or intramedullary devices are placed; that distinguishes this code from 27450, which covers the same osteotomy with fixation.

This is a 90-day global procedure. All routine post-op visits, cast checks, and wound care through day 90 are bundled. Anything unrelated billed in that window needs modifier 24 (E/M) or modifier 79 (unrelated procedure). A planned staged procedure — such as a subsequent fixation that was always part of the treatment plan — uses modifier 58.

If the procedure is performed bilaterally in the same session, append modifier 50. When performed on a single limb, use RT or LT to specify laterality. Payers will scrutinize the absence of fixation; the operative note must explicitly state that no fixation device was used, or the claim risks downcoding or denial in favor of 27450.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU11.31
Practice expense RVU9.11
Malpractice RVU2.41
Total RVU22.83
Medicare national rate$762.54
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
$762.54
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 27448 get rejected.

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

  • Downcoded to or denied in favor of 27450 when the operative note doesn't explicitly confirm absence of fixation
  • Medical necessity denied when pre-op imaging or diagnosis doesn't clearly support angular deformity correction
  • Bilateral procedure denied when modifier 50 is missing or when separate line items lack LT/RT modifiers
  • Global period violations when routine post-op visits are billed without modifier 24 within the 90-day window
  • ICD-10 mismatch — filing a deformity correction code against a diagnosis that doesn't reflect structural malalignment

Frequently asked questions

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

01What is the difference between CPT 27448 and CPT 27450?
27448 is the femoral shaft or supracondylar osteotomy performed without any fixation hardware. 27450 covers the identical osteotomy when fixation devices — plates, screws, pins, or an intramedullary implant — are placed. If any hardware goes in, bill 27450. The operative note must make the distinction explicit.
02What global period applies to 27448?
27448 carries a 90-day global period. The day-before visit, the surgery day, and all routine post-op care through day 90 are bundled. Use modifier 24 for unrelated E/M visits and modifier 79 for unrelated procedures performed during that window.
03Can 27448 be billed bilaterally?
Yes. When the osteotomy is performed on both femurs in the same operative session, append modifier 50 to 27448, or bill two line items with LT and RT respectively, depending on payer preference. Confirm bilateral billing policy with each payer before submitting.
04Which ICD-10 diagnoses support medical necessity for 27448?
Common supporting diagnoses include angular deformities of the femur (e.g., M21.0x, M21.1x series), acquired limb deformities, malunion of a femoral fracture (M84.35x), and developmental or post-traumatic malalignment. The diagnosis must reflect structural malalignment requiring corrective osteotomy — a vague deformity code without imaging support is a denial risk.
05If a second surgeon assists, how is that billed?
An assistant surgeon bills with modifier 80. A physician assistant or nurse practitioner billing for surgical assistance uses modifier AS. Payers vary on whether they recognize assistant surgeon reimbursement for this code, so verify coverage before the case.
06Can 27448 and 27450 ever be billed together?
Not for the same femur on the same date — they describe mutually exclusive approaches to the same osteotomy. If the surgeon performed osteotomies on both femurs and used fixation on one side but not the other, bill 27450 with LT (or RT) and 27448 with the opposite laterality modifier, with documentation supporting each.
07Is prior authorization commonly required for 27448?
Many commercial payers require prior authorization for elective femoral osteotomy. Submit pre-op imaging, the diagnosis, and the operative plan. Medicare does not require prior auth but applies medical necessity review, so documentation must support why the correction requires surgical osteotomy without fixation.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

  1. 01CMS Physician Fee Schedule 2026
  2. 02
    abos.org
    https://www.abos.org/wp-content/uploads/2019/12/sports-cpt-updated.pdf
  3. 03
    aapc.com
    https://www.aapc.com/codes/cpt-codes/27448
  4. 04
    cms.gov
    https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-faq-library
  5. 05
    cgsmedicare.com
    https://www.cgsmedicare.com/medicare_dynamic/j15/partb/ptpb/ptp.aspx
  6. 06
    findacode.com
    https://www.findacode.com/cpt/27448-cpt-code.html

Mira AI Scribe

Mira's AI scribe captures the osteotomy site (shaft vs. supracondylar), the absence of fixation devices, the deformity being corrected, and the post-op immobilization plan directly from surgeon dictation. That documentation trail is what separates a clean 27448 claim from a payer downcoding it to 27450 or flagging it for a fixation-device audit.

See how Mira captures CPT 27448 documentation

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