Repair of femoral nonunion or malunion (distal to femoral head and neck) using compression or other technique, without bone graft.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $1,085.20
- Total RVUs
- 32.49
- 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 6 cited references ↓
- Confirm fracture location as distal to the femoral head and neck — proximal femur nonunions code differently
- State whether bone graft was used; any graft use shifts the code to 27472
- Document the fixation technique used (e.g., compression plating, intramedullary nail, dynamic fixation)
- If hardware removal (20680) was also performed, document whether a separate incision was used and why removal was clinically distinct from the repair approach
- Operative note must specify the diagnosis — nonunion vs. malunion — supported by pre-op imaging and clinical findings
- Include pre-operative imaging (X-ray, CT) confirming nonunion or malunion with dates in the record
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 27470 covers surgical correction of a femur fracture that has failed to heal (nonunion) or healed in poor alignment (malunion), performed at any point along the femoral shaft distal to the head and neck, without the use of a bone graft. The compression technique is the classic approach — the surgeon stabilizes the fracture site using fixation hardware to restore mechanical continuity and promote healing. This code is explicitly distinguished from 27472, which applies when iliac crest or other autogenous graft is harvested and used.
This is a high-complexity procedure with a 90-day global period. All routine post-op care through day 90 is bundled. A critical NCCI bundling issue arises when hardware removal (20680) is performed through the same incision as the nonunion repair — payers routinely deny 20680 as separately billable in that scenario, arguing hardware removal is inseparable from accessing the nonunion site. If the hardware was removed through a distinct incision or a clearly separate surgical session, modifier 59 or XS supports unbundling with documentation to match.
CMS has designated 27470 as an inpatient-only procedure under the OPPS. That means Medicare does not pay for this code in an outpatient hospital or ASC setting — it must be performed and billed as an inpatient admission. The listed HOPD and ASC payment figures reflect non-Medicare commercial payer benchmarks only.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 16.71 |
| Practice expense RVU | 12.23 |
| Malpractice RVU | 3.55 |
| Total RVU | 32.49 |
| Medicare national rate | $1,085.20 |
| 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 | $1,085.20 |
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 27470 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Hardware removal (20680) bundled into 27470 when performed through the same incision without a separate-procedure modifier and supporting documentation
- Missing or insufficient pre-operative imaging confirming nonunion or malunion diagnosis before surgery
- Code billed in outpatient hospital or ASC setting — 27470 is Medicare inpatient-only (OPPS status C)
- Operative note lacks specificity on fixation technique, making medical necessity review difficult
- 27470 billed when graft was harvested and used — correct code in that scenario is 27472
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What is the difference between 27470 and 27472?
02Can 27470 be performed in an ASC or outpatient hospital under Medicare?
03Can I separately bill hardware removal (20680) with 27470?
04What ICD-10 diagnoses typically support 27470?
05Does the 90-day global period affect billing for a related complication that requires return to the OR?
06Can two surgeons co-bill 27470 using modifier 62?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/files/document/r11150cp.pdf
- 03aapc.comhttps://www.aapc.com/codes/cpt-codes/27470
- 04payerprice.comhttps://payerprice.com/rates/27470-CPT-fee-schedule
- 05aapc.comhttps://www.aapc.com/codes/coding-newsletters/my-orthopedic-coding-alert/reader-question-medicare-may-bundle-hardware-removal-article
- 06ama-assn.orghttps://www.ama-assn.org/system/files/cpt-assistant-may2022-update-musculoskeletal.pdf
Mira AI Scribe
Mira's AI scribe captures the fracture location relative to the femoral head and neck, fixation technique, whether bone graft was obtained, and the incision details for any concurrent hardware removal. That specificity prevents the two most common 27470 denials: upcoding to 27472 when no graft was used, and bundled 20680 denials when the operative note is silent on incision separation.
See how Mira captures CPT 27470 documentation