Percutaneous skeletal fixation of a distal femur fracture — medial or lateral condyle, supracondylar, or transcondylar — with or without intercondylar extension or distal femoral epiphyseal separation, using pins, screws, or wires inserted through the skin.

Verified May 8, 2026 · 7 sources ↓

Medicare: $652.65
Total RVUs: 19.54
Global, days: 90
Region: Knee

Drawn from CMSAbosAAPCAAOS

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify fracture location precisely: medial condyle, lateral condyle, supracondylar, transcondylar, or epiphyseal separation — vague 'distal femur fracture' documentation invites audit flags.
Confirm percutaneous approach in the operative note; if any open exposure occurred, the approach dictates a different code (27511, 27513, 27514, or 27519).
Document hardware type and placement: pin, screw, or wire; number of fixation points; fluoroscopic confirmation of reduction and alignment.
Note presence or absence of intercondylar extension — this distinction is captured in 27509 but becomes critical if open treatment is considered.
Record laterality (left vs. right) explicitly in the operative report and on the claim.
For epiphyseal separation cases, document patient age and physeal involvement to support the diagnosis code selection and medical necessity.

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 50 Bilateral procedure 51 Multiple procedures 57 Decision for surgery 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 XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 27509 covers percutaneous pin, screw, or wire fixation of fractures at the distal femur — specifically medial or lateral condyle, supracondylar, transcondylar, and fractures with intercondylar extension. Distal femoral epiphyseal separation is also captured under this code when treated percutaneously. The defining characteristic is the percutaneous approach: hardware is driven through the skin into bone without formal open exposure. If the surgeon converts to open fixation, step up to 27511, 27513, 27514, or 27519 depending on fracture pattern and intercondylar involvement.

The 90-day global period governs all post-op follow-up. Routine fracture checks, cast or splint changes, and hardware monitoring visits within 90 days are bundled. Bill modifier 24 on any E/M for a separate, unrelated condition during that window. If the decision to operate was made during the same encounter, append modifier 57 to the E/M — required for any major (90-day global) procedure.

Laterality modifiers LT and RT are expected by most payers; omitting them is a common clean-claim failure. Bilateral femoral fixation on the same day requires modifier 50 or separate line items with LT/RT. If a second, unrelated procedure occurs during the global period, use modifier 79. An unplanned return to the OR for a related complication (e.g., loss of reduction requiring repeat fixation) takes modifier 78 — not 79.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	7.94
Practice expense RVU	9.94
Malpractice RVU	1.66
Total RVU	19.54
Medicare national rate	$652.65
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	$652.65
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,899.69

Common denial reasons

The recurring reasons claims for CPT 27509 get rejected.

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

Missing laterality modifier (LT or RT) — most Medicare contractors and commercial payers reject 27509 without it.
Upcoded or miscoded approach: billing 27509 for a procedure that included open exposure; payers audit operative notes and will downcode or deny if the approach doesn't match percutaneous.
Bundling conflicts when fixation hardware removal (20670 or 20680) is billed same-day without modifier 59 or XS establishing a distinct service.
E/M billed same-day as 27509 without modifier 25, triggering automatic bundling denial even when the evaluation was separately identifiable.
Global period violations: post-op fracture visits billed without modifier 24 when the visit is for an unrelated condition, or without modifier 57 when decision for surgery was made at that encounter.

Frequently asked questions

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

01What's the difference between 27509 and 27511 or 27513?

27509 is strictly percutaneous fixation — pins, screws, or wires placed through the skin. 27511 and 27513 are open treatments of supracondylar/transcondylar fractures without and with intercondylar extension, respectively. If you opened the fracture site at all, 27509 is wrong.

02Do I need a laterality modifier every time?

Yes. Append LT or RT on every 27509 claim. Most Medicare contractors and commercial payers will reject the claim without it, and bilateral cases need modifier 50 or separate LT/RT line items.

03Can I bill an E/M on the same day as 27509?

Only if the E/M was a separately identifiable service beyond the pre-op assessment. Append modifier 25 to the E/M. If the E/M visit was where you made the decision to operate, also append modifier 57 — required for major (90-day global) procedures.

04What modifier applies if the patient returns to the OR for loss of reduction during the global period?

Modifier 78 — unplanned return to the OR for a related procedure during the postoperative period. Modifier 79 is for an unrelated procedure. Don't invert them; payers audit this distinction.

05Is distal femoral epiphyseal separation billable under 27509?

Yes, percutaneous fixation of distal femoral epiphyseal separation is included in 27509. Document patient age and physeal involvement to support diagnosis coding and medical necessity review.

06Can 27509 be billed bilaterally?

Yes. Use modifier 50 for same-day bilateral percutaneous fixation, or bill separate line items with LT and RT. Bilateral femoral fractures are uncommon and will draw scrutiny — document the clinical circumstances clearly.

07What happens if hardware removal is needed during the 90-day global?

Planned staged hardware removal (20670 or 20680) during the global period requires modifier 58 if it was anticipated at the time of the index procedure, or modifier 78 if the return was unplanned for a related reason. Neither is bundled automatically — modifier 59 or XS may also be needed depending on NCCI edits.

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 fracture site (condyle, supracondylar, transcondylar, or epiphyseal), confirms the percutaneous approach, logs hardware type and count, and records laterality directly from dictation. That prevents the two most common 27509 denials: approach-code mismatch and missing LT/RT modifier.

See how Mira captures CPT 27509 documentation