Open treatment of a distal femoral epiphyseal (growth plate) separation, including internal fixation when performed.

Verified May 8, 2026 · 6 sources ↓

Medicare: $810.97
Total RVUs: 24.28
Global, days: 90
Region: Knee

Drawn from CMSAbosAAPCFindacodePayerprice

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Patient age and skeletal maturity — growth plate injury diagnosis requires a skeletally immature patient and reviewers will flag adults
Operative note must name the approach used (e.g., medial parapatellar, lateral), not just 'standard approach'
Explicit documentation of open reduction — percutaneous fixation of a distal femoral epiphyseal separation is coded separately (27509)
Hardware type, size, and placement relative to the physis documented in the operative note
Imaging (intraoperative fluoroscopy or X-ray) findings confirming reduction and fixation, with notation of whether fluoroscopy guidance was integral to the procedure or a separately billable service
Fracture classification (Salter-Harris type) recorded — supports medical necessity and ICD-10 specificity

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 59 Distinct service 62 Co-surgeons 73 Discontinued pre-anesthesia 74 Discontinued post-anesthesia 76 Repeat, same physician 77 Repeat, another physician 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 27519 covers open reduction of a distal femoral epiphyseal separation — a fracture at the growth plate of the lower femur — with internal fixation performed as needed. This injury pattern occurs almost exclusively in skeletally immature patients; the physis is the mechanical weak point that fails before the ligaments do. Because the growth plate is involved, operative technique must account for hardware placement relative to the physis to minimize the risk of iatrogenic growth arrest.

The 090-day global period starts on the date of surgery. Preoperative evaluation on the day before surgery, the surgical encounter itself, and all routine postoperative visits through day 90 are bundled. Unrelated E/M services in that window require modifier 24. A same-day decision-for-surgery E/M needs modifier 57 if the service drove the operative decision.

Bilaterally, this injury is exceedingly rare, but if treated simultaneously use modifiers LT and RT on separate claim lines for ASC reporting. Confirm NCCI edits before billing any associated fluoroscopy or imaging guidance code — if intraoperative fluoroscopy is documented as integral to the fixation, it is not separately reportable.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	12.92
Practice expense RVU	8.61
Malpractice RVU	2.75
Total RVU	24.28
Medicare national rate	$810.97
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	$810.97
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,682.29

Common denial reasons

The recurring reasons claims for CPT 27519 get rejected.

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

ICD-10 code mismatch — using an adult distal femur fracture code instead of a physeal/epiphyseal separation code (S79.1xx series)
Unbundling of intraoperative fluoroscopy when payer treats it as integral to 27519 and not separately payable
Global period violations — routine post-op visits billed without modifier 24 or 79 within the 90-day window
Medical necessity denial when documentation lacks evidence of failed or inappropriate non-operative management, or when injury severity doesn't support open reduction over closed or percutaneous approaches
Wrong code selected — 27509 (percutaneous fixation) used when operative note clearly describes open exposure and direct reduction

Frequently asked questions

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

01How does 27519 differ from 27509?

27509 covers percutaneous skeletal fixation of a distal femoral epiphyseal separation — no open exposure. 27519 requires open reduction with direct visualization of the fracture site. If your operative note describes a formal incision and direct reduction, 27519 is correct. If fixation was placed percutaneously under fluoroscopy without opening the fracture, use 27509.

02Can I bill separately for intraoperative fluoroscopy with 27519?

Only if fluoroscopy was used for a distinct purpose beyond confirming reduction of the fracture itself. Many payers treat intraoperative fluoroscopy as integral to open fracture fixation. Document whether fluoroscopy was used solely for fracture confirmation (likely bundled) or for a separate imaging purpose. Check NCCI edits before appending a fluoroscopy code.

03What ICD-10 codes support 27519?

Use codes from the S79.1 series (physeal fracture of lower end of femur) with the appropriate Salter-Harris type suffix and laterality. S79.101 through S79.199 cover the range. Confirm the type in the operative and radiology reports — payers cross-check ICD-10 specificity against operative documentation.

04What modifier applies if I perform an unrelated procedure during the 90-day global?

Modifier 79 covers an unrelated procedure performed during the global period of 27519. If the second procedure is related to a complication of the original surgery, use modifier 78 instead. Inverting these two modifiers is a common audit flag.

05Is modifier 22 ever appropriate for 27519?

Yes, when the procedure is substantially more complex than typical — for example, a severely displaced Salter-Harris IV with comminution requiring prolonged reconstruction, or a case with prior hardware complicating exposure. Document extra time, complexity, and clinical circumstances in the operative note. Modifier 22 without supporting documentation is a near-automatic downcode or denial.

06Does the 90-day global include postoperative casting or splinting changes?

Yes. Routine cast changes, splint adjustments, and wound checks within 90 days are bundled into the global. If a cast change requires a significant, separately identifiable service unrelated to the fracture care, append modifier 24 to the E/M and document the distinct medical necessity.

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 Salter-Harris classification, the specific open approach used, hardware type and physis-relative placement, intraoperative fluoroscopy use (integral vs. additional), and the patient's skeletal maturity from surgeon dictation. That detail set prevents the two most common 27519 denials: ICD-10 mismatch due to missing fracture specificity and fluoroscopy unbundling flags.

See how Mira captures CPT 27519 documentation