Closed treatment of a femoral shaft fracture without manual reduction or manipulation — the bone is immobilized and allowed to heal in its current position.

Verified May 8, 2026 · 6 sources ↓

Medicare: $574.50
Work RVU: 6.14
Global, days: 90
Region: Knee

Drawn from CMSAAPCFindacodeAAOSGenhealth

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Imaging confirming femoral shaft fracture location and pattern (AP and lateral radiographs at minimum)
Explicit documentation that no manipulation was performed — state 'closed treatment without manipulation' in the note
Description of immobilization method used (e.g., splint, cast, skeletal traction device) and extremity position
Laterality documented — left or right femur — to support LT/RT modifier use
Clinical rationale for non-operative management (e.g., fracture alignment acceptable, patient comorbidities, age-related factors)
Follow-up imaging plan documented to demonstrate intent to monitor healing under global period care

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 52 Reduced services 57 Decision for surgery 58 Staged or related 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27500 covers closed (non-surgical) management of a femoral shaft fracture where no manipulation of the fracture fragments is performed. The treating physician stabilizes the limb — typically via cast, splint, or traction — and monitors healing through serial imaging. No attempt is made to manually realign displaced fragments under this code; if manipulation is performed, a different code applies.

This code carries a 90-day global period. That window covers the procedure itself, the day-before decision visit (use modifier 57 on the E/M), and all routine post-op management through day 90. Separate E/M visits within the global for unrelated conditions require modifier 24. A staged or planned subsequent procedure in the global period requires modifier 58.

The key distinction driving code selection in the femoral shaft fracture family is surgical versus non-surgical and manipulation versus no manipulation. 27500 is the no-manipulation closed option. Open treatment with IM nail goes to 27506; open treatment with plate/screws goes to 27507. Miscode between these and you're looking at a medical necessity mismatch with the operative note.

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 (6.14) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (17.2) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	6.14
Practice expense RVU	9.75
Malpractice RVU	1.31
Total RVU	17.2
Medicare national rate	$574.50
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	$574.50
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI A2) Ambulatory surgical center (freestanding)	$135.54

Common denial reasons

The recurring reasons claims for CPT 27500 get rejected.

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

Operative note describes manipulation or reduction — payer downcodes or denies in favor of the manipulation code
Missing laterality — claims without LT or RT modifier flagged or suspended by many payers
E/M billed same day without modifier 57 when the decision for surgery was made at that visit (90-day global triggers requirement)
ICD-10 diagnosis code does not specify femoral shaft — fracture coded to distal femur or proximal femur mismatches this code
Separate fracture care billed by a second provider during the 90-day global without modifier 79 for unrelated procedure or proper documentation of transfer of care

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What's the difference between 27500 and 27501?

27501 covers closed treatment of a femoral shaft fracture WITH manipulation — meaning the provider manually reduces the fracture fragments. 27500 is reserved for cases where the fracture is treated in position without any reduction attempt. The operative note must explicitly support whichever code you bill.

02Does 27500 require a cast or traction to be applied?

The code requires that the fracture be treated — immobilization (cast, splint, or traction) is the expected clinical management and should be documented, but the defining characteristic of 27500 is the absence of manipulation, not the specific immobilization device used.

03Can I bill an E/M the same day as 27500?

Only with modifier 57 if the visit represents the decision for surgery (i.e., the decision to initiate fracture care). The 90-day global period absorbs routine pre-op work. Use modifier 25 if a separately identifiable E/M for an unrelated problem was performed that day, though modifier 57 is more commonly applicable here given the major global.

04Which ICD-10 codes pair with 27500?

Use S72.3xx codes for femoral shaft fractures — specifically the appropriate 7th character for encounter type (A for initial, D for subsequent, S for sequela). Fractures coded to the distal or proximal femur do not map to 27500 and will generate a medical necessity mismatch on audit.

05If the patient returns within 90 days for surgical fixation, what modifier applies?

Use modifier 58 — staged or related procedure by the same physician during the postoperative period. This applies when the escalation to open fixation (e.g., 27506 or 27507) was anticipated or becomes necessary during the global period. Modifier 58 resets the global period clock. Do not use modifier 78 here unless it was an unplanned return to the OR for a complication.

06Is 27500 billable bilaterally?

Bilateral femoral shaft fractures are rare but would require modifier 50 or separate line items with LT and RT modifiers. Each fracture should be supported by separate imaging and clinical documentation. Most payers will scrutinize bilateral billing for this code closely.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures the absence of manipulation directly from dictation — pulling the phrase 'no manipulation performed' or 'fracture treated without reduction' into the procedure note and flagging laterality. This prevents the most common audit trigger for 27500: operative notes that fail to explicitly state no reduction was attempted, which reviewers use to challenge whether the higher-complexity manipulation code should have been billed instead.

See how Mira captures CPT 27500 documentation