Closed treatment of a distal femoral epiphyseal (growth plate) separation without manipulation — stabilizing the fracture without open surgery or repositioning the displaced fragment.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $573.16
- Total RVUs
- 17.16
- 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 5 cited references ↓
- Confirm patient is skeletally immature — document open physes on imaging
- State explicitly that no manipulation was performed and why alignment was deemed acceptable
- Record Salter-Harris classification and laterality in both the note and ICD-10 selection
- Describe the immobilization method applied (cast, splint, brace) and position of the extremity
- Include pre- and post-treatment imaging findings to support the chosen management approach
- Document neurovascular status of the limb before and after treatment
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 5 cited references ↓
CPT 27516 covers closed, non-manipulative treatment of a distal femoral physis fracture — the kind of Salter-Harris injury seen in skeletally immature patients where the growth plate separates from the femoral shaft or epiphysis. Because no manipulation is performed, this code applies when the fracture alignment is acceptable and the treating physician elects immobilization rather than reduction. The distinction between 27516 (no manipulation) and 27517 (with manipulation) is critical; billing the wrong code based on incomplete operative documentation is the most common audit trigger for this code family.
The 90-day global period covers all routine follow-up through day 90 — immobilization checks, cast changes, and wound care. Any E/M visit for a new problem during that window requires modifier 24. If you're managing a growth arrest complication that requires a separate procedure, modifier 78 covers unplanned returns for related procedures; modifier 79 covers unrelated procedures in the global window. Because this is a pediatric injury pattern, ICD-10 specificity matters — laterality and Salter-Harris type must align with the operative note and imaging findings.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 5.45 |
| Practice expense RVU | 10.54 |
| Malpractice RVU | 1.17 |
| Total RVU | 17.16 |
| Medicare national rate | $573.16 |
| 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 | $573.16 |
HOPD (APC 5111) Hospital outpatient department | $252.01 |
ASC (PI A2) Ambulatory surgical center (freestanding) | $135.54 |
Common denial reasons
The recurring reasons claims for CPT 27516 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- ICD-10 code missing laterality or Salter-Harris type, causing mismatched diagnosis-to-procedure pairing
- Documentation does not explicitly state that no manipulation was performed, leaving ambiguity between 27516 and 27517
- Global period conflict — E/M visit billed same-day without modifier 25, or post-op visit billed without modifier 24
- Payer flags skeletally mature patient age against a growth plate fracture code — missing supporting imaging documentation
- Bilateral billing submitted without modifier 50 or separate line entries with LT/RT modifiers
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01What is the difference between CPT 27516 and 27517?
02Does CPT 27516 have a global period, and what does it include?
03Which ICD-10 codes are typically paired with CPT 27516?
04Can CPT 27516 be billed bilaterally?
05What modifier applies if the patient returns within 90 days for a growth arrest requiring surgery?
06Is CPT 27516 appropriate for adult patients?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02aapc.comhttps://www.aapc.com/codes/cpt-codes/27516
- 03cms.govhttps://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-policy-manual
- 04mdclarity.comhttps://www.mdclarity.com/cpt-code/27516
- 05billrazor.comhttps://billrazor.com/procedures/27516-treat-thigh-fx-growth-plate
Mira AI Scribe
Mira's AI scribe captures the absence of manipulation, the Salter-Harris classification, limb laterality, the immobilization method applied, pre- and post-treatment alignment assessment, and neurovascular exam findings from dictation. This prevents the most common denial pattern for 27516: documentation that doesn't distinguish closed treatment without manipulation from closed treatment with manipulation, leaving auditors no basis for the code selected over 27517.
See how Mira captures CPT 27516 documentation