Surgical arrest of distal femoral growth plate (epiphysiodesis) to equalize limb length discrepancy
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $627.27
- Work RVU
- 8.71
- 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 5 cited references ↓
- Pre-operative standing full-length radiographs documenting measured limb length discrepancy in centimeters
- Skeletal age assessment (bone age study) confirming sufficient remaining growth to achieve equalization
- Operative note naming the specific technique used (open drilling/curettage vs. percutaneous screw epiphysiodesis)
- Laterality explicitly documented — right, left, or bilateral — with each affected physis identified
- Clinical indication linking the discrepancy to the diagnosis code (e.g., congenital, post-traumatic, post-infectious)
- Surgeon attestation that the growth plate was targeted and the degree of physeal destruction achieved
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 5 cited references ↓
CPT 27475 describes surgical epiphysiodesis at the distal femur, where the surgeon partially or completely ablates the growth plate to halt longitudinal bone growth on the longer side, allowing the shorter limb to catch up. The procedure is performed in skeletally immature patients with documented limb length discrepancy and sufficient remaining growth potential to justify intervention. Techniques include open physeal curettage/drilling or percutaneous screw-based methods; the specific technique should be named in the operative note.
The code carries a 90-day global period. All routine post-op visits, wound checks, and stitch removals through day 90 are bundled. Unrelated problems treated in that window require modifier 24 on the E/M. If a complication sends the patient back to the OR for a related procedure, bill that return with modifier 78. An unrelated surgical problem addressed during the global period uses modifier 79.
Lateral and medial modifiers (LT/RT) apply when only one side is treated. If both distal femora are addressed in the same session, append modifier 50. When the procedure is performed bilaterally and also involves the proximal tibia (27477), each code is reported with the appropriate side modifier and modifier 51 for the secondary code.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (8.71) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (18.78) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 8.71 |
| Practice expense RVU | 8.22 |
| Malpractice RVU | 1.85 |
| Total RVU | 18.78 |
| Medicare national rate | $627.27 |
| 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 | $627.27 |
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 27475 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing or insufficient bone age documentation to justify timing of physeal arrest
- Laterality not specified in the operative note, triggering a missing-modifier edit
- Procedure billed without prior authorization when payer requires PA for pediatric growth-arrest surgery
- ICD-10 diagnosis code mismatch — using an adult limb-deformity code instead of a congenital or acquired discrepancy code appropriate for a skeletally immature patient
- Global period conflict when a post-op visit is billed without modifier 24 for an unrelated condition within the 90-day window
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01When should I use modifier 50 vs. LT/RT on 27475?
02Can 27475 and 27477 be billed together?
03What ICD-10 codes pair correctly with 27475?
04Is fluoroscopic guidance separately billable with 27475?
05Does the 90-day global period create billing problems for the cast or brace checks afterward?
06When does modifier 22 apply to 27475?
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/27475
- 03mdclarity.comhttps://www.mdclarity.com/cpt-code/27475
- 04cms.govhttps://www.cms.gov/files/document/2025nccimedicarepolicymanualcompletepdf.pdf
- 05emedny.orghttps://www.emedny.org/providermanuals/physician/pdfs/physician%20procedure%20codes%20sect5.pdf
Mira Scribe
Mira's AI scribe captures the specific physis targeted (distal femur medial, lateral, or complete), surgical technique by name (percutaneous screw vs. open drill-and-curet), measured limb length discrepancy in centimeters, bone age at time of surgery, and laterality. This prevents the two most common denials on 27475: missing bone-age support for medical necessity and absent laterality that triggers a modifier edit at the payer.
See how Mira captures CPT 27475 documentation