Open surgical repair of a femoral supracondylar or transcondylar fracture that extends into the intercondylar region, with internal fixation as needed.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $1,106.91
- Total RVUs
- 33.14
- Global, days
- 90
- Region
- Knee
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 identify the fracture pattern by name — supracondylar/transcondylar with intercondylar extension — and confirm the articular split was addressed.
- Document the specific fixation construct used: implant type, size, and configuration (e.g., lateral locking plate, retrograde nail, dual-plating).
- Pre-operative imaging (X-ray or CT) confirming distal femur fracture with intercondylar extension must be in the record and referenced in the note.
- Document patient positioning, surgical approach (e.g., lateral, posterior, or combined), and any intraoperative fluoroscopy confirming reduction quality.
- If modifier 22 is billed for increased complexity, include specific narrative: additional time, unusual difficulty, or complicating factors such as severe comminution, obesity, or prior hardware.
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 6 cited references ↓
CPT 27513 covers open reduction of a distal femur fracture where the fracture line runs above or across the condyles and also extends down into the intercondylar space — the classic T- or Y-shaped supracondylar/intercondylar pattern. The intercondylar extension is what separates 27513 from 27511, which covers the same fracture geometry without that articular split. Fixation typically involves plates, screws, retrograde intramedullary nails, or combinations thereof, but the hardware used does not change the code selection.
The procedure carries a 90-day global period. Pre-op visits the day before surgery, the surgery itself, and all routine post-op care through day 90 are bundled. Unrelated E/M services in that window require modifier 24. A staged or planned subsequent procedure in the global period requires modifier 58; an unplanned return to the OR for a related complication requires modifier 78.
Site of service matters here. HOPD and ASC payments differ substantially — see the Site of Service comparison table on this page. Most of these cases are performed in the hospital inpatient or HOPD setting given the complexity and patient acuity; ASC billing is less common but is used for select 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 | 18.77 |
| Practice expense RVU | 10.41 |
| Malpractice RVU | 3.96 |
| Total RVU | 33.14 |
| Medicare national rate | $1,106.91 |
| 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 | $1,106.91 |
HOPD (APC 5115) Hospital outpatient department | $13,116.76 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $9,030.96 |
Common denial reasons
The recurring reasons claims for CPT 27513 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Code mismatch: 27513 billed but imaging or operative note supports 27511 (no intercondylar extension documented).
- Missing or vague operative note — notes that say 'distal femur ORIF' without specifying the intercondylar component trigger downcoding or medical records requests.
- Global period conflicts: post-op visits billed without modifier 24 within the 90-day window.
- Laterality missing: payers increasingly require LT or RT on unilateral procedures; absent laterality modifier causes claim rejection at clearinghouse.
- Authorization not obtained or obtained for the wrong procedure code, particularly when fracture pattern was upgraded from 27511 intraoperatively.
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What is the difference between CPT 27511 and 27513?
02Does the type of hardware used affect which code to bill?
03How does the 90-day global period affect billing for this code?
04Can 27513 be billed bilaterally?
05When is modifier 22 appropriate for 27513?
06Is pre-authorization typically required for 27513?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/files/document/r13573cp.pdf
- 03aapc.comhttps://www.aapc.com/codes/cpt-codes/27513
- 04fastrvu.comhttps://fastrvu.com/cpt/27513
- 05mdclarity.comhttps://www.mdclarity.com/cpt-code/27513
- 06vsac.nlm.nih.govhttps://vsac.nlm.nih.gov/context/cs/codesystem/CPT/version/2020/code/27513/info
Mira AI Scribe
Mira's AI scribe captures the fracture pattern descriptor (supracondylar, transcondylar, intercondylar extension), fixation method and implant type, surgical approach, and intraoperative fluoroscopy findings from the surgeon's dictation. That specificity prevents the most common denial for this code: a note that says 'distal femur fracture' without confirming the intercondylar split that justifies 27513 over 27511.
See how Mira captures CPT 27513 documentation