Multiple osteotomies of the femoral shaft with realignment on an intramedullary rod — the Sofield-type procedure for severe femoral deformity correction.

Verified May 8, 2026 · 5 sources ↓

Medicare: $1,181.39
Total RVUs: 35.37
Global, days: 90
Region: Knee

Drawn from CMSEmedny

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify number and anatomic location of each osteotomy site on the femoral shaft
Document intramedullary rod type, length, and diameter used for fixation
Include preoperative imaging (plain films or CT) demonstrating the femoral deformity requiring correction
State the underlying diagnosis driving the deformity (e.g., osteogenesis imperfecta, prior malunion, metabolic bone disease)
Document failed conservative management or functional impairment justifying surgical intervention
Operative note must name the specific realignment technique — do not use generic language like 'standard approach'

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 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon 24 Unrelated E/M during global 25 Significant separate E/M LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 27454 describes a femoral shaft realignment procedure involving multiple osteotomies stabilized with an intramedullary rod — classically the Sofield procedure, originally developed for osteogenesis imperfecta but applied to any severe, multi-level femoral deformity requiring segmental correction and internal fixation.

The 90-day global period covers all routine postoperative care through day 90, including hardware monitoring visits, routine radiographs, and dressing changes. Separate E/M visits during that window require modifier 24 if unrelated to the osteotomy. Any return to the OR for an unplanned, related complication — such as hardware failure or infection washout — gets modifier 78. An unrelated procedure in the global window gets modifier 79.

This is a high-complexity, low-volume procedure. Operative documentation must be granular: number of osteotomy sites, rod type and sizing, fixation technique, and the underlying deformity diagnosis with supporting imaging. Payers will scrutinize medical necessity closely. Radiographic evidence of the deformity and chart documentation of failed conservative management or functional impairment are non-negotiable for clean claims.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	18.69
Practice expense RVU	12.7
Malpractice RVU	3.98
Total RVU	35.37
Medicare national rate	$1,181.39
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	$1,181.39
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 27454 get rejected.

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

Medical necessity not established — missing radiographic evidence of deformity severity in the record
Operative note lacks specificity on number of osteotomy sites or rod fixation details, triggering audit or downcoding
Routine post-op E/M billed within the 90-day global without modifier 24, causing automatic denial
Incorrect modifier 79 used for a related return-to-OR complication instead of modifier 78
Diagnosis code does not support femoral shaft deformity requiring multi-level osteotomy — unspecified fracture or deformity codes without laterality

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What distinguishes 27454 from a single femoral osteotomy code like 27448?

27454 requires multiple osteotomies with intramedullary rod stabilization — the Sofield-type construct. A single femoral shaft osteotomy without IM rod realignment bills under 27448. If you performed multiple cuts and placed a rod for alignment, 27454 is the correct code.

02Can 27454 be billed bilaterally?

Yes. If both femora are corrected in the same session, append modifier 50 and bill on a single line. Reimbursement is typically capped at 150% of the single-procedure fee schedule amount. Document each limb's osteotomy sites and fixation separately in the operative note.

03What modifier applies if the patient returns to the OR within the global period for a broken rod?

Modifier 78 — unplanned return to the OR for a complication related to the original procedure. Hardware failure is directly related to the 27454. Do not use modifier 79, which is reserved for unrelated procedures performed during the global period.

04Is fluoroscopic guidance separately billable with 27454?

No. Intraoperative fluoroscopy used for rod placement and alignment confirmation is integral to the procedure under NCCI policy. Do not separately report fluoroscopy codes with 27454.

05What diagnosis codes support medical necessity for 27454?

Codes describing femoral deformity — including deformity due to osteogenesis imperfecta, malunion of prior femoral fracture, or metabolic bone disease with bowing — are appropriate. Use the most specific ICD-10 code available with laterality. Unspecified deformity codes without supporting imaging increase denial risk significantly.

06Can a co-surgeon bill for this procedure?

Yes, if the complexity genuinely requires two surgeons operating simultaneously. Each surgeon appends modifier 62 and documents their distinct role in the operative note. Payers may request documentation justifying co-surgery on high-RVU procedures like this one.

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 number of osteotomy sites, intramedullary rod specifications, and the named realignment technique directly from dictation, then flags operative notes that omit osteotomy count or use generic fixation language — the two documentation gaps most likely to trigger a medical necessity denial or post-payment audit on this low-volume, high-RVU procedure.

See how Mira captures CPT 27454 documentation