Open treatment of a femoral shaft fracture using an intramedullary implant, with or without external fixation, cerclage, or locking screws.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,223.14
Total RVUs: 36.62
Global, days: 90
Region: Knee

Drawn from CMSAAPCKzanowAbosFindacode

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Fracture location confirmed as femoral shaft — not intertrochanteric, supracondylar, or distal femur
Operative note specifies open reduction was performed, not percutaneous or closed technique
Type of intramedullary implant documented (e.g., retrograde nail, antegrade nail) and fixation details (locking screws, cerclage)
Pre-op imaging (X-ray or CT) confirming femoral shaft fracture pattern and displacement requiring open treatment
Laterality documented (left vs. right femur) in both the operative note and diagnosis codes
If external fixation applied, note its use — it is included in 27506 and must not be billed separately
If multiple fractures treated same session, each fracture site clearly described with anatomic location to support modifier 59 or XS if needed

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 51 Multiple procedures 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

27506 covers open reduction of a femoral shaft fracture with insertion of an intramedullary nail — retrograde or antegrade — including any external fixation, cerclage wiring, and locking screws placed during the same operative session. The nail insertion is bundled into the code descriptor; do not report it separately. This is the go-to code for IM nailing of mid-shaft femur fractures requiring open reduction.

The code carries a 90-day global period. That window covers the day-before and day-of surgery, the procedure itself, and all routine post-op management through day 90. Any E/M visit in that window for a new or unrelated problem needs modifier 24. If the decision for surgery was made the day of or day before an E/M visit, append modifier 57 to that E/M.

Do not report 27506 alongside 27245 (intramedullary fixation of intertrochanteric femur fracture) on the same femur. There is an NCCI mutually exclusive edit pairing these two codes — the payer will deny one. If the patient has fractures at genuinely separate sites requiring distinct procedures, document each fracture site explicitly and apply modifier 59 or XS with supporting operative note detail.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	19.16
Practice expense RVU	13.43
Malpractice RVU	4.03
Total RVU	36.62
Medicare national rate	$1,223.14
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	$1,223.14
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,699.15

Common denial reasons

The recurring reasons claims for CPT 27506 get rejected.

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

NCCI mutually exclusive edit: billing 27506 and 27245 together for ipsilateral femur without modifier 59 or XS and distinct operative documentation
Laterality missing or mismatched — ICD-10 fracture code laterality does not match the operative site
Nail insertion billed separately (e.g., as an implant procedure code) when it is already bundled into 27506
E/M visit billed same-day as surgery without modifier 25 or 57, triggering denial as included in global
Wrong code selected — distal femur or supracondylar fractures treated with IM nail sometimes miscoded as 27506 instead of the appropriate distal femur code (27511, 27513)

Frequently asked questions

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

01Does 27506 include the intramedullary nail insertion, or should I bill that separately?

It is included. The code descriptor explicitly covers insertion of an intramedullary implant. Billing a separate nail insertion code will trigger a bundling edit and denial.

02Can I bill 27506 and 27245 together when the patient has both a shaft fracture and an intertrochanteric fracture on the same femur?

There is an NCCI mutually exclusive edit between 27506 and 27245. If both fractures are genuinely distinct and treated as separate procedures, you need modifier 59 or XS plus explicit operative note documentation of each fracture site and its separate treatment. Without that, expect one code to be denied.

03What is the global period for 27506, and what modifiers do I need during that window?

27506 carries a 90-day global period. Use modifier 24 for unrelated E/M visits within the global. Use modifier 78 for an unplanned return to the OR for a related complication. Use modifier 79 for an unrelated procedure in the OR during the global period.

04The surgeon used a retrograde nail for a distal femoral shaft fracture — is 27506 still correct?

Yes, if the fracture is in the femoral shaft. Retrograde nail approach is still captured by 27506. If the fracture is supracondylar or transcondylar, you are in 27511 or 27513 territory — confirm anatomic location on imaging before coding.

05When should modifier 22 be appended to 27506?

Append modifier 22 when the procedure required substantially greater work than typical — for example, a severely comminuted fracture, morbid obesity significantly complicating access and fixation, or a pathological fracture requiring additional complexity. Document the specific factors that increased operative time and difficulty. Payers require a written narrative; without one, modifier 22 will be ignored or denied.

06Is 27506 appropriate for a pathological femoral shaft fracture through a metastatic lesion?

The CPT code can be used for pathological fractures, but confirm the ICD-10 diagnosis code reflects a pathological fracture (M84.55x series) rather than a traumatic fracture. Payer LCDs may require additional documentation of the underlying diagnosis and medical necessity for surgical fixation versus non-operative management.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures fracture location (shaft vs. proximal vs. distal femur), reduction technique (open vs. closed), implant type and configuration (antegrade vs. retrograde nail, locking screw pattern, cerclage use), laterality, and whether external fixation was applied. That specificity prevents the two most common 27506 audit flags: miscoding distal femur fractures as shaft fractures, and triggering NCCI edits from an insufficiently documented multi-fracture operative note.

See how Mira captures CPT 27506 documentation