Open surgical repair of a patellar fracture involving internal fixation hardware, with optional partial or complete removal of the kneecap and repair of the surrounding soft tissue structures.

Verified May 8, 2026 · 5 sources ↓

Medicare: $705.09
Total RVUs: 21.11
Global, days: 90
Region: Knee

Drawn from CMSAAPCMdclarityPayerprice

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Fracture pattern described with imaging correlation — comminuted, transverse, or stellate — and displacement measurement
Operative note specifies fixation construct used (tension band, cannulated screws, cerclage, plate) with implant details
Documentation of any patellectomy performed — partial vs. complete — and extent of bone removed
Soft tissue repair detailed: extensor mechanism integrity, retinacular tear location, repair technique
Laterality explicitly stated (right vs. left patella) to support LT/RT modifier and avoid claim rejection
Pre-op neurovascular status and post-op range-of-motion or stability assessment documented

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 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 27524 covers open reduction and internal fixation of a patellar fracture, with the option for partial or complete patellectomy and soft tissue repair performed in the same operative session. This is the highest-complexity patellar fracture code — use it when the fracture requires open exposure, hardware placement (tension band wiring, screw fixation, or similar constructs), and soft tissue reconstruction. It is not the correct code for closed treatment with or without manipulation.

The 90-day global period means all routine fracture follow-up visits, wound checks, and hardware monitoring through day 90 are bundled. Separate E/M visits during the global require modifier 24 (unrelated medical issue) or are not separately billable. If the patient returns to the OR for a related complication — hardware failure, infection washout — append modifier 78. An unrelated surgical problem in the same global window gets modifier 79.

Site of service matters here. The HOPD facility payment is roughly double the ASC rate. When the procedure is performed in an inpatient setting, DRG assignment drives the facility payment rather than OPPS. The surgeon's professional fee follows the Medicare Physician Fee Schedule regardless of site, but the site-of-service differential affects the non-facility vs. facility practice expense RVUs applied to the total.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.11
Practice expense RVU	8.89
Malpractice RVU	2.11
Total RVU	21.11
Medicare national rate	$705.09
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	$705.09
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI G2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 27524 get rejected.

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

Missing laterality modifier — payers reject unilateral knee procedure claims without LT or RT
Upcoding from 27520 challenged when operative note lacks explicit mention of internal fixation hardware or soft tissue repair
Global period E/M visits billed without modifier 24 or 25, triggering automatic bundling denial
Insufficient imaging documentation to support open versus closed treatment selection
Modifier 78 omitted on return-to-OR claim during the 90-day global, causing denial as duplicate service

Frequently asked questions

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

01When does 27524 apply instead of 27520?

27520 is for closed treatment of a patellar fracture without manipulation. Use 27524 any time you open the knee, place internal fixation, perform a patellectomy, or repair the soft tissue envelope — regardless of whether those elements appear in combination.

02Can 27524 and a knee arthroscopy be billed together on the same day?

Rarely, and expect scrutiny. If arthroscopy is performed through a separate portal for a distinct indication — not just to inspect the fracture site — append modifier 59 or XS and document the separate clinical rationale thoroughly. NCCI edits bundle many arthroscopy codes with open fracture repair.

03How do you bill a return to the OR for hardware removal during the global period?

If hardware removal is necessitated by a complication related to the original fixation, bill the removal code with modifier 78 (unplanned return, related procedure). If hardware removal was a planned staged procedure, use modifier 58. Modifier 79 applies only for a completely unrelated surgical problem.

04Is bilateral patella fixation on the same day realistic, and how is it billed?

Bilateral traumatic patellar fractures are uncommon but do occur in high-energy mechanisms. If both patellae are fixed in the same session, bill 27524-50. Some payers require separate line items with LT and RT instead of modifier 50 — verify by payer before submitting.

05Does modifier 22 apply when the fracture is highly comminuted or the repair is unusually complex?

Yes, but the bar is high. Modifier 22 requires documentation that the work substantially exceeded what the code normally entails — operative time significantly above average, unusual anatomic complexity, or extensive soft tissue damage. Include a cover letter quantifying the increased work when submitting with modifier 22.

06What ICD-10 codes are typically paired with 27524?

S82.00x series covers patellar fractures — use the appropriate 7th character for initial encounter (A or B depending on open vs. closed), subsequent encounter, or sequela. Initial open treatment maps to the A/B encounter characters; be consistent with laterality between the ICD-10 and the LT/RT modifier.

Sources & references

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

01CMS Physician Fee Schedule 2026
02
aapc.com
https://www.aapc.com/codes/cpt-codes/27524
03
mdclarity.com
https://www.mdclarity.com/cpt-code/27524
04
payerprice.com
https://payerprice.com/rates/27524-CPT-fee-schedule
05
cms.gov
https://www.cms.gov/regulations-and-guidance/guidance/transmittals/downloads/r3674cp.pdf

Mira AI Scribe

Mira's AI scribe captures the fixation construct, patellectomy extent, and soft tissue repair detail directly from dictation — the three elements auditors target when distinguishing 27524 from the lower-complexity 27520. It also flags laterality if not stated, preventing the single most common clean-claim failure on patellar fracture cases.

See how Mira captures CPT 27524 documentation