Surgical repair of femoral nonunion or malunion (distal to the head and neck) using an autogenous iliac crest or other autograft, with graft harvest included in the code.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,156.01
Total RVUs: 34.61
Global, days: 90
Region: Other

Drawn from CMSAAPCGenhealthMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Imaging (X-ray, CT, or MRI) confirming nonunion or malunion of the femur distal to the head and neck, with dates of original fracture and failed healing
Operative note specifying graft donor site (e.g., iliac crest), graft type (cancellous, cortical, or combined), and volume harvested
Documentation of prior surgical or conservative treatment attempts, including any prior fixation hardware still in place or removed
Intraoperative fluoroscopy or imaging findings confirming fracture site preparation and graft placement
Laterality clearly stated in both the diagnosis and operative note (left vs. right femur)
Medical necessity narrative explaining why autograft was chosen over allograft or synthetic substitute, if queried by payer

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 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 27472 covers open surgical correction of a femoral nonunion or malunion at any location distal to the femoral head and neck, performed with autogenous bone graft. Graft harvest — whether from the iliac crest or another donor site — is bundled into 27472 and cannot be billed separately. The procedure addresses failed fracture healing or angular/rotational deformity of the femur shaft and is almost exclusively performed by orthopedic surgeons.

The 90-day global period means all routine postoperative care — wound checks, suture removal, cast or brace management, and follow-up imaging interpretation billed as part of the visit — is included through day 90. Any E/M or procedure for an unrelated condition during that window requires modifier 24 or 79, respectively. Complex wound closure (e.g., 13121) is inherently bundled into 27472 per AAOS global surgical package policy and cannot be unbundled even with modifier 59.

Site-of-service matters here: the HOPD and ASC payment differentials are significant (see the Site of Service comparison table on this page). Payers may require prior authorization given the RVU weight of this code, and documentation of prior conservative or surgical management of the nonunion/malunion is routinely requested on pre-auth and retrospective audit.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	18.25
Practice expense RVU	12.48
Malpractice RVU	3.88
Total RVU	34.61
Medicare national rate	$1,156.01
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	$1,156.01
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,816.61

Common denial reasons

The recurring reasons claims for CPT 27472 get rejected.

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

Graft harvest billed separately (e.g., 20900–20902) when harvest is already included in 27472 descriptor
Complex wound closure (13121) billed alongside 27472 — inherently bundled per AAOS global package policy
Missing or insufficient imaging evidence of nonunion or malunion prior to surgery, triggering medical necessity denial
Laterality modifier (LT or RT) absent, causing claim to be flagged or returned by payer
Prior authorization not obtained before scheduling, particularly common for high-RVU musculoskeletal reconstruction cases
E/M visit billed in global period without modifier 24, resulting in automatic denial

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Is bone graft harvest separately billable with 27472?

No. Graft harvest is explicitly included in the 27472 descriptor. Billing 20900, 20902, or similar harvest codes alongside 27472 will be denied as unbundled.

02Can complex wound closure (13121) be billed with 27472?

No. Per AAOS global surgical package policy, closure of tissues divided for surgical exposure is included in 27472. These codes are considered inherently bundled and modifier 59 does not override this.

03When is modifier 22 appropriate for 27472?

Use modifier 22 when the procedure is substantially more complex than typical — for example, revision of a prior failed fixation with retained hardware removal, extensive debridement of fibrous nonunion tissue, or morbid obesity complicating exposure. The operative note must explicitly describe the increased work and time.

04What modifier applies if the patient needs a return to the OR during the 90-day global for a complication at the nonunion site?

Use modifier 78. That covers an unplanned return to the OR for a related procedure — such as wound dehiscence or hardware failure at the same femoral site — during the 90-day global period.

05Can 27472 be billed bilaterally?

Bilateral femoral nonunion repair in a single session is rare but possible. If performed, append modifier 50 and document medical necessity for bilateral surgery. Most payers will require explicit documentation that both femora meet nonunion or malunion criteria independently.

06What ICD-10 diagnosis codes support 27472?

M84.35x- (stress fracture, femur), M84.55x- (pathological fracture, femur), M96.8x (other intraoperative and postprocedural complications), and M84.35x- nonunion sequelae codes are commonly paired. Use the most specific code reflecting nonunion vs. malunion and laterality.

07Does 27472 require prior authorization?

Most commercial payers and Medicare Advantage plans require prior authorization for high-RVU femoral reconstruction procedures. Confirm with each payer. Retrospective denials for missing auth on this code are difficult to overturn.

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 donor site (iliac crest vs. other), graft type (cancellous, cortical, structural), confirmation of nonunion vs. malunion, laterality, prior fixation history, and intraoperative findings from dictation — preventing the most common audit flag: an operative note that documents the graft harvest site ambiguously or omits prior treatment history, which triggers medical necessity denial on retrospective review.

See how Mira captures CPT 27472 documentation