Open surgical repair of a distal femur fracture involving the medial or lateral condyle, with internal fixation when performed.

Verified May 8, 2026 · 5 sources ↓

Medicare: $875.10
Total RVUs: 26.2
Global, days: 90
Region: Knee

Drawn from CMSEmednyAAPCCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify which condyle is involved: medial or lateral — generic 'distal femur fracture' is insufficient for audit.
Confirm open approach was used and document the incision site and method of fracture exposure.
Detail internal fixation hardware used (plate, screws, type/size) or explicitly note fixation was not performed and why.
Include intraoperative fluoroscopy or imaging confirmation of reduction and hardware position.
Document fracture classification and mechanism of injury to support medical necessity.
Record neurovascular status of the limb pre- and post-reduction.

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 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

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 27514 covers open treatment of a distal femoral fracture at the medial or lateral condyle. The surgeon opens the fracture site, reduces the fragment(s), and stabilizes the condyle with internal fixation hardware — screws, plates, or a combination — when clinically indicated. This is a condyle-specific code: fractures of the femoral shaft or supracondylar/transcondylar region without condylar extension map to different codes (27513 with intercondylar extension, 27512 without).

The 90-day global period covers the day before surgery, the operative session, and all routine follow-up through day 90. Separate E&M visits within that window require modifier 24 (unrelated) or 25 (same-day, significant, separately identifiable). 27514 is bundled under CCI when reported same-day with 27447 (TKA) — the AAPC forum confirms this bundle is not overridable during an intraoperative fracture scenario unless distinct anatomic separation and separate documentation support modifier use.

This code is performed in a hospital operating room. Site-of-service differences between HOPD and ASC payments are material — see the Site of Service comparison table on this page. Internal fixation hardware (screws, plates) is not separately billable under CMS; it is considered part of the surgical service.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	14.24
Practice expense RVU	8.96
Malpractice RVU	3
Total RVU	26.2
Medicare national rate	$875.10
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	$875.10
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$9,239.02

Common denial reasons

The recurring reasons claims for CPT 27514 get rejected.

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

Code billed same-day as 27447 (TKA) — CCI bundles 27514 into 27447 with no modifier override for routine intraoperative fracture.
Wrong code selected: supracondylar fractures without condylar involvement map to 27512 or 27513, not 27514.
Operative note does not confirm open treatment — closed or percutaneous approaches do not support this code.
Missing laterality modifier (LT or RT) required by many commercial payers and some MACs.
Global period conflict: post-op visit billed without modifier 24 or 25 within the 90-day window.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What's the difference between 27513 and 27514?

27513 covers open treatment of a supracondylar or transcondylar femoral fracture with intercondylar extension. 27514 is for an isolated condyle fracture — medial or lateral — at the distal femur. If the fracture crosses into the intercondylar region, 27513 is the right code, not 27514.

02Can I bill 27514 with 27447 if a condyle fracture occurred intraoperatively during TKA?

No. CCI bundles 27514 into 27447, and AAPC coding forums confirm this edit is not bypassable with a modifier in the intraoperative fracture scenario. The condyle repair is considered part of the TKA work.

03Is internal fixation hardware separately billable?

Not under CMS. Hardware — screws, plates, locking constructs — is included in the 27514 reimbursement and cannot be billed separately to Medicare or Medicaid.

04What modifier applies if the surgeon treats a condyle fracture unrelated to the original procedure during the global period?

Use modifier 79 (unrelated procedure or service by the same physician during the postoperative period). Do not use 78 — that is for unplanned returns for a related procedure.

05Does 27514 require a laterality modifier?

CMS does not mandate LT/RT for 27514, but many commercial payers and some MACs do. Appending LT or RT is best practice and prevents laterality-based denials.

06What ICD-10 codes typically support 27514?

Displaced and nondisplaced fractures of the medial condyle (S72.41x) and lateral condyle (S72.42x) of the femur are the primary diagnosis codes. Specify laterality (1=right, 2=left) and initial encounter (A) vs. subsequent (D) as appropriate.

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 condyle involved (medial vs. lateral), surgical approach, fracture reduction method, and internal fixation hardware details directly from the operative dictation. It flags when the note uses only generic language like 'distal femur' without specifying condylar location — the most common audit trigger for 27514 that leads to downcoding or denial.

See how Mira captures CPT 27514 documentation