Open treatment of a femoral supracondylar or transcondylar fracture without intercondylar extension, including internal fixation when performed.

Verified May 8, 2026 · 6 sources ↓

Medicare: $900.82
Total RVUs: 26.97
Global, days: 90
Region: Knee

Drawn from CMSCdn-linksNIHAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative note must confirm fracture location as supracondylar or transcondylar — absence of intercondylar extension must be explicitly documented or inferable from imaging findings
Specify fixation method used (plate and screws, retrograde nail, cerclage, etc.) to support medical necessity and distinguish from other distal femur fracture codes
Pre-operative imaging (X-ray or CT) referenced in the operative note confirming fracture pattern and classification
Document whether the fracture is traumatic or pathologic; pathologic fractures require corresponding ICD-10 diagnosis codes (e.g., M84.552- for pathologic fracture of distal femur)
Surgical approach documented by name — lateral, medial, or combined; audit teams flag notes that generically reference 'standard approach'
For periprosthetic fractures in patients with prior TKA, document the implant status and whether the existing prosthesis was addressed, as this affects code selection

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 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 27511 covers open surgical treatment of a distal femur fracture at the supracondylar or transcondylar level, specifically cases where the fracture does not extend into the intercondylar notch. Internal fixation — plates, screws, or similar implants — is included in the code when performed; you do not bill separately for the fixation hardware placement. This distinguishes 27511 from 27513, which applies when there is intercondylar extension, and from 27514, which applies to isolated medial or lateral condyle fractures.

The 90-day global period means all routine post-op visits, wound checks, and hardware-related follow-up are bundled through day 90. Unrelated E/M visits in that window require modifier 24. A new problem or complication requiring a separate decision requires modifier 25 on the E/M and, if a return to the OR is needed, modifier 78 for related unplanned procedures or modifier 79 for unrelated ones. Pathologic fractures (e.g., metastatic disease) are a valid use case for 27511 but require supporting ICD-10 diagnosis codes; missing or mismatched diagnosis codes are a leading denial trigger for these cases.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	14.73
Practice expense RVU	9.13
Malpractice RVU	3.11
Total RVU	26.97
Medicare national rate	$900.82
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	$900.82
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$9,256.60

Common denial reasons

The recurring reasons claims for CPT 27511 get rejected.

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

ICD-10 diagnosis code does not match the fracture site or type billed under 27511, particularly when pathologic fracture codes are absent for oncologic cases
Upcoding dispute when intercondylar extension is not clearly excluded — payers may challenge 27511 versus 27513 without explicit imaging or operative documentation
Separate billing for internal fixation components already included in 27511, triggering NCCI bundling edits
Global period violations — post-op E/M visits billed without modifier 24 when they fall within the 90-day window
Missing or insufficient operative documentation for periprosthetic fracture cases, leading to medical necessity denials when the fracture pattern and prior implant status are not described

Frequently asked questions

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

01What is the difference between 27511, 27513, and 27514?

27511 is for supracondylar or transcondylar fractures without intercondylar extension. 27513 applies when the fracture extends into the intercondylar notch. 27514 covers isolated medial or lateral femoral condyle fractures. Operative and imaging documentation must clearly support whichever pattern you bill.

02Is internal fixation separately billable when performed with 27511?

No. Internal fixation is included in 27511 when performed. Billing a separate fixation code triggers NCCI bundling edits and will be denied.

03Can 27511 be used for a periprosthetic distal femur fracture after TKA?

27511 can apply to periprosthetic distal femur fractures, but the operative note must document the existing implant status and confirm that the prosthesis was not revised or replaced. If the TKA components were addressed, code selection shifts. Add modifier 22 if the periprosthetic location significantly increased operative complexity.

04How do you bill 27511 for a pathologic fracture from metastatic disease?

Bill 27511 with a pathologic fracture ICD-10 code (e.g., M84.552- series) rather than a traumatic fracture code. Mismatched diagnosis codes — traumatic fracture codes on a clearly oncologic case — are a top denial reason for this scenario.

05What modifier applies if the patient returns to the OR during the global period for a complication directly related to the original fracture repair?

Modifier 78 applies for an unplanned return to the OR for a complication related to the original procedure during the 90-day global. Do not use modifier 79, which is reserved for unrelated procedures during the global period.

06Does the 90-day global period affect how post-op E/M visits are billed?

Yes. All routine post-op visits through day 90 are bundled. If you see the patient for a problem unrelated to the fracture repair, append modifier 24 to the E/M code. Without it, the claim will deny as a global period service.

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 (supracondylar vs. transcondylar), confirms absence of intercondylar extension from intraoperative findings, records the fixation construct used, and flags the surgical approach by name — all directly from dictation. That prevents the most common audit trigger for 27511: operative notes that fail to distinguish the fracture pattern from intercondylar variants, which invites downcoding challenges on review.

See how Mira captures CPT 27511 documentation