Open treatment of a femoral shaft fracture using plate and screw fixation, with or without cerclage wire.

Verified May 8, 2026 · 6 sources ↓

Medicare: $883.45
Total RVUs: 26.45
Global, days: 90
Region: Hip

Drawn from CMSAAPCMdclarityFindacodeAbos

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Explicitly name the fixation construct: plate type, screw configuration, and whether cerclage wire was used
Identify the fracture pattern and location within the femoral shaft (AO/OTA classification preferred)
Document whether an existing implant (arthroplasty, prior IM nail) was present and how it affected the surgical approach
Record fluoroscopic or intraoperative imaging confirming reduction and implant position
Note any significant complexity — comminution, bone loss, extended operative time — to support modifier 22 if applicable
Confirm laterality (left vs. right) to support LT/RT modifiers

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 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27507 covers open reduction and internal fixation (ORIF) of a femoral shaft fracture using plates and screws, with or without cerclage wire. This is the plate-and-screw pathway for femoral shaft repair — distinct from 27506, which covers intramedullary nail fixation. Choosing the wrong code between these two is among the most common billing errors on femoral shaft cases. The operative note must name the implant construct explicitly.

The global period is 90 days. All routine fracture-related follow-up, wound checks, and hardware monitoring visits are bundled. Billing a separate E/M within the global window requires modifier 24 (unrelated) or 25 (significant, separately identifiable same-day service). Complications requiring a return to the OR for a procedure related to the original fixation should be billed with modifier 78; an unrelated OR procedure in the global period uses modifier 79.

Periprosthetic femoral fractures — fractures occurring around an existing implant (hip arthroplasty, prior nail) — can complicate code selection and may require modifier 22 if the complexity substantially increases operative time and work. Document the presence of existing hardware, the fracture pattern relative to the implant, and any additional technical steps required.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	14.12
Practice expense RVU	9.34
Malpractice RVU	2.99
Total RVU	26.45
Medicare national rate	$883.45
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	$883.45
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,057.25

Common denial reasons

The recurring reasons claims for CPT 27507 get rejected.

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

Code mismatch: billing 27507 (plate/screws) when operative note describes an IM nail — should be 27506
Missing laterality modifier when payer requires LT or RT for unilateral procedures
Global period conflicts: post-op E/M billed without modifier 24 or 25, triggering automatic bundle denial
Insufficient documentation of implant type when payer requests operative records to validate code selection
Modifier 22 submitted without a supporting narrative explaining the specific factors that increased complexity and operative time

Frequently asked questions

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

01What is the difference between CPT 27507 and 27506?

27506 is intramedullary nail fixation of the femoral shaft (with or without cerclage or locking screws). 27507 is plate-and-screw fixation. The operative note must identify the construct — payers and auditors use that language to validate the code, and upcoding between these two is a known audit target.

02Does 27507 have a 90-day global period?

Yes. The 90-day global covers the day before surgery through 90 days post-op, including all routine fracture follow-up, wound care, and hardware monitoring. Any unrelated E/M in that window needs modifier 24; a significant same-day separate service needs modifier 25.

03How do you bill a return to the OR for hardware failure or malunion during the global period?

Use modifier 78 if the return is for a procedure directly related to the original fixation (e.g., revision plating for hardware failure). Use modifier 79 if the OR procedure is unrelated to the femoral fracture repair.

04When is modifier 22 appropriate for 27507?

Modifier 22 applies when the work substantially exceeds what the code typically requires — for example, a periprosthetic fracture around a prior arthroplasty requiring implant management, severe comminution, or significant intraoperative complications. Submit a written explanation with the claim; without it, payers will deny or downgrade the modifier.

05Can 27507 be billed with an assistant surgeon?

Yes. For complex femoral shaft ORIF, an assistant surgeon is clinically appropriate and Medicare-payable. Bill the assistant using modifier 80 (MD assistant) or AS (PA/NP/CRNA first assist). Verify individual payer policies — some commercial payers require prior authorization for assistant surgeon charges.

06How do you code a periprosthetic femoral shaft fracture around a hip implant?

27507 remains the primary code when plate-and-screw fixation is used. If the presence of the existing implant substantially increases operative complexity, append modifier 22 with documentation. Some scenarios involving implant removal or revision may require additional codes — document each distinct procedure separately.

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 fixation construct (plate type, screw count, cerclage use), fracture pattern and AO/OTA classification, laterality, presence of existing hardware, and fluoroscopic confirmation of reduction — all from dictation. That eliminates the most common audit flag on 27507 cases: operative notes that name the fracture but fail to specify the implant construct, which auditors use to challenge the 27507 vs. 27506 code choice.

See how Mira captures CPT 27507 documentation