Open surgical treatment of a unicondylar tibial plateau fracture, with internal fixation performed when needed.

Verified May 8, 2026 · 7 sources ↓

Medicare: $815.32
Total RVUs: 24.41
Global, days: 90
Region: Knee

Drawn from CMSAbosAAPCEmednyCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify which condyle is involved — medial or lateral — confirming unicondylar pattern to distinguish from 27536
Describe the surgical approach by name (e.g., anteromedial, anterolateral, posteromedial) — notes that say 'standard approach' flag on audit
Document fracture reduction method and confirmation of alignment (fluoroscopic images, intraoperative AP and lateral views)
Identify all internal fixation hardware used: plate type, screw count, size, and placement — especially if modifier 22 is claimed for complexity
Record laterality (left vs. right knee) explicitly in the operative report and on the claim
If splint or cast applied at end of case, note it is part of the fracture care — do not generate a separate strapping charge

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 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 7 cited references ↓

CPT 27535 covers open reduction of a proximal tibial (plateau) fracture involving a single condyle — medial or lateral. The surgeon makes a direct incision, reduces the fracture under visualization, and typically secures fixation with screws, a plate, or a combination of hardware. Internal fixation is included in the code when performed; you don't add a separate fixation code. The 90-day global period absorbs the preoperative day-before visit, the surgery itself, and all routine postoperative care through day 90.

Distinguishing 27535 from adjacent codes is the most common coding pitfall. Use 27536 when both condyles are involved (bicondylar plateau fracture). Use 27540 for intercondylar spine or tibial tuberosity fractures — a meaningfully different anatomy. If the procedure is arthroscopically aided rather than fully open, 29855 applies instead. Conflating any of these leads to claim denial or audit exposure.

Casting or splinting applied at the same operative session is bundled into 27535 — do not bill a separate strapping code. If a same-day E/M drove the decision to operate, append modifier 57 to that E/M service. Surgeries performed on the left or right knee require modifier LT or RT; bilateral cases (rare in this context) require modifier 50.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	13.07
Practice expense RVU	8.59
Malpractice RVU	2.75
Total RVU	24.41
Medicare national rate	$815.32
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	$815.32
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,060.12

Common denial reasons

The recurring reasons claims for CPT 27535 get rejected.

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

Wrong code selected: 27535 billed for a bicondylar plateau fracture that requires 27536
Wrong code selected: 27535 billed for a tibial tuberosity or intercondylar spine fracture that requires 27540
Missing laterality modifier — payers require LT or RT on unilateral procedures at this joint
Separate casting or splinting code billed alongside 27535, which NCCI bundles into the fracture care code
E/M service billed same day without modifier 57, triggering a medical-decision-making bundling denial

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What is the difference between 27535 and 27536?

27535 is for a unicondylar plateau fracture — one condyle, medial or lateral. 27536 covers bicondylar fractures involving both condyles, with or without internal fixation. Imaging and the operative report must confirm which pattern is present. Billing 27535 for a bicondylar fracture is a mismatch that will deny on audit.

02When should 27540 be used instead of 27535?

Use 27540 for open treatment of intercondylar spine or tibial tuberosity fractures — anatomically distinct from the tibial plateau. A tibial tubercle ORIF, for example, maps to 27540, not 27535. The AAPC forum has debated this distinction; the key is the fracture location documented in the operative report.

03Can 27535 and 29855 both be billed if the surgeon used a scope to assist the open reduction?

No. 29855 is specifically for arthroscopically aided tibial plateau fracture treatment (unicondylar). If the procedure is primarily open with incidental scope use, use 27535. If the arthroscope is the primary visualization tool, use 29855. Billing both for the same fracture is a bundling violation.

04Does the 90-day global period include hardware removal?

Routine wound care and office visits are included. Planned staged hardware removal is a separate billable event — use modifier 58 (staged or related procedure by same surgeon during the postoperative period). Unplanned return to the OR for a related complication uses modifier 78.

05Can an E/M service be billed on the same day as 27535?

Yes, but only if the E/M involved a separately identifiable medical decision — typically the decision to operate. Append modifier 57 to the E/M code. Without modifier 57, the E/M bundles into the surgical package and will deny.

06Is modifier 62 (co-surgeon) applicable to 27535?

Yes, if two surgeons of different specialties each perform a distinct portion of the procedure and each dictates their own operative report, modifier 62 applies to both claims. Each surgeon bills 27535 with modifier 62 and must document their specific role.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures condyle laterality (medial vs. lateral), surgical approach name, reduction technique, fluoroscopic confirmation, and a full hardware inventory including plate type and screw dimensions from the surgeon's dictation. That specificity is what separates a clean 27535 claim from one that gets kicked back for insufficient documentation — or upcoded to 27536 without clinical support.

See how Mira captures CPT 27535 documentation