Surgical shortening of the femur by removing a bone segment and stabilizing the remaining ends — performed to correct leg length discrepancy or malunion.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $1,293.62
- Total RVUs
- 38.73
- Global, days
- 90
- Region
- Knee
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 6 cited references ↓
- Measured leg length discrepancy documented preoperatively, including method (scanogram, CT scout, clinical measurement) and magnitude in centimeters
- Operative note must specify the amount of bone resected and the fixation method used (IM nail, plate, external fixator)
- Indication stated explicitly — whether leg length discrepancy, malunion, or deformity correction — with supporting imaging referenced
- Post-resection alignment confirmed intraoperatively; document fluoroscopic or radiographic verification of correction
- Laterality documented clearly (left or right femur) to match claim modifiers LT or RT
- Any staged or planned subsequent procedures noted in the operative report to support modifier 58 if applicable
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 6 cited references ↓
CPT 27465 covers osteoplasty of the femur for shortening: the surgeon resects a measured segment of the femoral shaft, then secures the remaining bone ends with internal fixation to restore alignment and equalize limb length. Indications include leg length discrepancy (congenital, post-traumatic, or post-oncologic) and femoral malunion where the bone has healed in unacceptable alignment.
The procedure carries a 90-day global period. That window covers the day-before visit, the operative day, and all routine post-op management through day 90 — including fracture checks, hardware monitoring visits, and wound care. Any E/M visit during the global for an unrelated condition requires modifier 24. A new, unrelated surgical procedure in the global period requires modifier 79.
Site of service matters: HOPD and ASC payments differ significantly (see the Site of Service comparison table). Bilateral cases are rare but possible — femoral shortening is occasionally performed bilaterally in select skeletal dysplasia or post-traumatic scenarios, requiring modifier 50. When performing 27465 alongside other femoral reconstruction procedures in the same session, modifier 51 applies to the secondary 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 | 20.6 |
| Practice expense RVU | 13.74 |
| Malpractice RVU | 4.39 |
| Total RVU | 38.73 |
| Medicare national rate | $1,293.62 |
| 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 | $1,293.62 |
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 27465 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing or vague indication — operative note says 'LLD' without a documented measurement or imaging reference
- Laterality mismatch between the operative report, the claim modifier (LT/RT), and the supporting imaging
- Global period conflict — post-op E/M billed without modifier 24 when visit is for an unrelated condition during the 90-day window
- Insufficient documentation of amount of bone resected, leaving auditors unable to confirm the osteoplasty was performed as coded
- Modifier 79 used instead of 78 (or vice versa) when returning to OR during the global period — inversion triggers payment recoupment
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What is the global period for CPT 27465?
02When do you use modifier 58 with 27465?
03Can 27465 be billed bilaterally?
04How does 27465 differ from a femoral osteotomy for deformity correction (e.g., 27448)?
05Is modifier 22 ever appropriate for 27465?
06What ICD-10 diagnoses most commonly support 27465?
07Does 27465 include intraoperative fluoroscopy?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02aapc.comhttps://www.aapc.com/codes/cpt-codes/27465
- 03vsac.nlm.nih.govhttps://vsac.nlm.nih.gov/context/cs/codesystem/CPT/version/2019/code/27465/info
- 04mdclarity.comhttps://www.mdclarity.com/cpt-code/27465
- 05aaos.orghttps://www.aaos.org/globalassets/quality-and-practice-resources/coding-and-reimbursement/resident-guide/resident-guide_modifiers.pdf
- 06abos.orghttps://www.abos.org/wp-content/uploads/2019/12/sports-cpt-updated.pdf
Mira AI Scribe
Mira's AI scribe captures the measured leg length discrepancy (in cm), the surgical technique for bone resection, the amount of femoral segment removed, the fixation construct used, and intraoperative confirmation of correction from the surgeon's dictation. This prevents the most common audit flag for 27465: operative notes that document a shortening was performed without specifying the measured resection or the fixation method, which triggers medical necessity denials and downcoding.
See how Mira captures CPT 27465 documentation