Closed treatment of a proximal tibial fracture (tibial plateau) performed without manipulation to stabilize the tibia and allow proper bone healing.
Verified May 8, 2026 · 7 sources ↓
- Medicare
- $349.04
- Total RVUs
- 10.45
- 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 7 cited references ↓
- Pre-treatment imaging confirming proximal tibial (plateau) fracture with fracture pattern and displacement status noted
- Explicit statement that no manipulation was performed and clinical rationale for non-manipulative treatment
- Type of immobilization applied (cast, splint, brace) with laterality documented
- Neurovascular status of the extremity assessed and recorded pre- and post-immobilization
- ICD-10 diagnosis code supporting proximal tibia fracture with laterality (e.g., S82.10xA initial encounter)
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 7 cited references ↓
CPT 27530 covers closed treatment of a proximal tibial (plateau) fracture without manipulation. The treating physician stabilizes the injury — typically through immobilization such as casting or splinting — without attempting to reposition bone fragments. This is appropriate when the fracture is nondisplaced or minimally displaced and alignment is deemed acceptable on imaging without hands-on reduction.
The 90-day global period applies. That window covers the day-before visit, the procedure itself, and all routine post-op management through day 90 — including cast checks, follow-up imaging reviews, and routine office visits for the fracture. Billing a separate E/M for a fracture-related visit in that window requires modifier 24 with documentation that the visit addressed a problem distinct from fracture management.
The key code-selection decision is manipulation versus no manipulation. If the fracture required closed reduction — hands-on repositioning of the fragment — you must use 27532 instead. Upcoding to 27532 without documenting manipulation is a common audit target. Conversely, downcoding 27532 to 27530 when manipulation occurred leaves RVUs on the table and misrepresents the procedure.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 2.58 |
| Practice expense RVU | 7.34 |
| Malpractice RVU | 0.53 |
| Total RVU | 10.45 |
| Medicare national rate | $349.04 |
| 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 | $349.04 |
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 27530 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Fracture manipulation documented in the note but 27530 (no manipulation) billed — should be 27532
- Separate E/M billed same-day for fracture management without modifier 25 on the E/M
- Routine fracture follow-up visit billed separately inside the 90-day global without modifier 24
- Laterality missing — payer requires LT or RT modifier for unilateral fracture treatment
- ICD-10 diagnosis does not specify proximal tibia or lacks required 7th character for encounter type
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 7 cited references ↓
01What's the difference between 27530 and 27532?
02Can I bill an E/M on the same day as 27530?
03How does the 90-day global period affect follow-up billing?
04Do I need LT or RT modifiers when billing 27530?
05If the patient returns to the OR within the global period for internal fixation, which modifier applies?
06What ICD-10 codes pair with 27530?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/files/document/cy2025-diy-tables-01-23-2026.xlsx
- 03vsac.nlm.nih.govhttps://vsac.nlm.nih.gov/context/cs/codesystem/CPT/version/2019/code/27530/info
- 04aapc.comhttps://www.aapc.com/codes/cpt-codes/27530
- 05findacode.comhttps://www.findacode.com/cpt/27530-cpt-code.html
- 06aaos.orghttps://www.aaos.org/education/about-aaos-products/coding-resources/
- 07aoassn.orghttps://www.aoassn.org/wp-content/uploads/2020/12/CodingTTP.pdf
Mira AI Scribe
Mira's AI scribe captures the fracture location (proximal tibia, specific plateau column if noted), displacement status from imaging, and the explicit clinical decision not to manipulate. It flags laterality from dictation and auto-populates the encounter type character in the ICD-10 suggestion. This prevents the most common audit flag for 27530: operative or clinical notes that document a reduction attempt while the claim bills the no-manipulation code.
See how Mira captures CPT 27530 documentation