Closed reduction of a distal femoral growth plate separation with manipulation, using skin or skeletal traction as needed to restore alignment in a skeletally immature patient.

Verified May 8, 2026 · 5 sources ↓

Medicare: $653.66
Work RVU: 8.89
Global, days: 90
Region: Knee

Drawn from CMSAAPCFindacodeEmednyNovitas

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Confirm skeletally immature patient — radiographic evidence of open distal femoral physis required
Salter-Harris classification documented in the operative or procedure note
Description of manipulation technique and whether skin or skeletal traction was applied
Pre- and post-reduction fluoroscopic or radiographic findings confirming fracture alignment
Operative note distinguishes closed reduction (27517) from open reduction (27519) — no ambiguity in approach language
If assistant at surgery billed with modifier 80 or AS, operative note must name the assistant and describe active participation

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 52 Reduced services 57 Decision for surgery 58 Staged or related 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 27517 covers closed treatment of a distal femoral epiphyseal separation with manipulation — meaning the surgeon reduces the displaced growth plate fracture without opening the skin, applying skin or skeletal traction when necessary to maintain alignment. This is a pediatric injury by definition: the distal femoral physis is only present in skeletally immature patients, making age and radiographic confirmation of an open growth plate mandatory documentation elements.

The code sits in a three-code family for distal femoral epiphyseal injuries. Use 27516 when no manipulation is required. Step up to 27519 when open reduction with or without internal fixation is performed. If the fracture cannot be held with closed means and you convert to open fixation, 27519 is the correct code — don't bill 27517 and 27519 together for the same injury. The 90-day global period covers all routine follow-up, traction adjustments, and cast changes through day 90. Separate E/M visits in that window require modifier 24 with documentation of a distinct medical problem.

Growth plate injuries in children are frequently missed at initial presentation, and payers look for ICD-10 codes that specifically identify a physeal fracture (Salter-Harris classification) rather than a generic distal femur fracture code. Mismatched diagnosis coding is a leading denial trigger for 27517. Salter-Harris type should be specified in the operative note and on the claim.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (8.89) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (19.57) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	8.89
Practice expense RVU	8.78
Malpractice RVU	1.9
Total RVU	19.57
Medicare national rate	$653.66
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	$653.66
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 27517 get rejected.

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

ICD-10 diagnosis code does not specify a physeal or growth plate injury — generic distal femur fracture codes trigger mismatch edits
Claim submitted as 27519 (open) when documentation supports only closed reduction, or vice versa
Post-op E/M visits billed without modifier 24 during the 90-day global period
Patient age or radiographic findings do not support an open physis, undermining medical necessity
Traction supplies or casting billed separately when included in the global package

Frequently asked questions

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

01What is the difference between CPT 27516, 27517, and 27519?

27516 is closed treatment without manipulation. 27517 adds manipulation — with or without skin or skeletal traction. 27519 is open reduction with or without internal fixation. Bill based on what was actually performed, not on fracture severity alone.

02Can I bill 27517 and 27519 together if I attempt closed reduction and then convert to open?

No. If you convert to open reduction during the same operative session, bill only 27519. Billing both codes for the same injury and same session will trigger a bundling edit.

03Does 27517 carry a global period, and what does it include?

Yes — 90-day global. Routine post-op visits, traction adjustments, cast changes, and dressing changes through day 90 are all bundled. Unrelated E/M services need modifier 24; a new problem treated at a post-op visit needs modifier 24 with documentation of the distinct condition.

04What ICD-10 codes should I use with 27517?

Use Salter-Harris physeal fracture codes for the distal femur (S79.1xx series), specifying type (I–IV) and laterality. Avoid generic distal femur fracture codes — payers flag the mismatch between a physeal CPT code and a non-physeal diagnosis code.

05Can 27517 be billed bilaterally?

Bilateral distal femoral physeal fractures are rare but not impossible. If treated bilaterally in the same session, append modifier 50 and confirm your payer accepts bilateral billing for this code — some Medicaid programs require LT/RT on separate lines instead.

06When is modifier 22 appropriate for 27517?

Modifier 22 applies when the reduction requires substantially increased work — for example, a severely displaced or irreducible fracture requiring prolonged traction and multiple manipulation attempts. Document the additional time, difficulty, and clinical factors explicitly; without that narrative, payers will not uphold the increased payment.

07Can a PA or NP bill for assisting at surgery on 27517?

Yes, with modifier AS. The PA or NP must accept assignment, and the operative note must document the assistant's name and active role in the procedure — ancillary presence alone does not qualify.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures the Salter-Harris fracture type, the specific manipulation technique, whether skin or skeletal traction was applied, pre- and post-reduction alignment findings, and the patient's skeletal maturity status from the procedure dictation. That prevents the two most common denial triggers for 27517: a generic fracture diagnosis that doesn't map to a physeal injury, and an operative note that doesn't clearly distinguish closed reduction from open treatment.

See how Mira captures CPT 27517 documentation