Closed treatment of fracture(s) of the intercondylar spine(s) and/or tuberosity of the knee, with or without manipulation — no surgical opening of the joint.

Verified May 8, 2026 · 7 sources ↓

Medicare: $538.76
Work RVU: 4.96
Global, days: 90
Region: Knee

Drawn from CMSAAPCFindacodeGenhealth

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specific anatomic site — intercondylar spine and/or tuberosity — must be named in the note, not just 'knee fracture'
Confirm closed approach: document that no surgical incision or internal fixation was performed
State whether manipulation was performed and describe the technique used
Imaging (X-ray or fluoroscopy) confirming fracture and post-reduction alignment; note if fluoroscopy was used intraoperatively
Document who will assume follow-up care — this determines whether casting codes can be billed separately
ICD-10 fracture code must specify laterality and, where applicable, fracture type and encounter (initial vs. subsequent)

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 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 27538 covers closed (non-operative) management of intercondylar spine or tibial tuberosity fractures at the knee. The provider reduces the fracture — with or without manipulation — without making a surgical incision into the joint. This distinguishes it from 27540, which is the open treatment counterpart requiring internal fixation.

The 90-day global period applies. Initial casting, splinting, or strapping is bundled into 27538 when the treating provider also assumes follow-up care; do not separately bill casting codes in that scenario. If a different provider applies only the initial cast and does not plan to manage follow-up, the NCCI Policy Manual permits billing an E&M, a casting code, and a supply code instead.

Fracture coding in the 27500–27566 range turns on three variables: anatomic site, fracture type, and approach (closed vs. open vs. percutaneous). Confirm the operative or treatment note specifies the intercondylar spine or tuberosity as the fracture site. A note that just documents 'knee fracture' without anatomic specificity is an audit target and a denial waiting to happen.

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 (4.96) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (16.13) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	4.96
Practice expense RVU	10.11
Malpractice RVU	1.06
Total RVU	16.13
Medicare national rate	$538.76
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	$538.76
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 27538 get rejected.

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

Non-specific fracture documentation — 'tibial fracture' or 'knee fracture' without naming the intercondylar spine or tuberosity
Separate billing of casting or splinting codes when the treating provider assumed follow-up care — bundled into the global under NCCI policy
Upcoding to 27540 (open treatment) when the operative note does not document a surgical incision or internal fixation
Missing laterality modifier (LT or RT) causing claim rejection or edit flag
Global period violations — billing routine follow-up E&M visits within the 90-day global without modifier 24

Frequently asked questions

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

01What separates 27538 from 27540?

Approach and fixation. 27538 is closed treatment — no incision, no hardware. 27540 is open treatment with internal fixation. If the operative note describes any incision into the joint or placement of fixation hardware, 27540 is the correct code.

02Can I bill casting codes separately with 27538?

Not if you're managing follow-up. The NCCI Policy Manual is explicit: casting, splinting, and strapping are bundled into the fracture care code when the treating provider assumes the follow-up. Only bill casting codes separately if a provider applies an initial cast with no plan to follow the patient.

03Does 27538 need a laterality modifier?

Yes. Append LT or RT to identify the treated knee. Payers and MAC edits routinely flag knee fracture codes submitted without laterality, and some payers will reject the claim outright.

04What modifier covers an E&M visit on the same day as 27538?

Modifier 25 on the E&M if a separate, significant evaluation was performed on the same date — for example, evaluating a comorbidity or deciding on the treatment approach before proceeding. Document the E&M separately and ensure it stands on its own medical necessity.

05How does the 90-day global period affect billing for complications?

Routine post-op visits, dressing changes, and fracture checks within 90 days are bundled — don't bill them separately. If a complication requires a return to the OR for a related procedure (e.g., fracture displacement requiring conversion to open treatment), use modifier 78. An unrelated procedure during the global period gets modifier 79.

06Is fluoroscopy separately billable with 27538?

Only if CMS instructions allow separate reporting for that imaging service in this context. Per NCCI Chapter 4, if radiologic guidance is used in the course of the fracture treatment itself, check whether it is separately reportable or bundled before billing a fluoroscopy code alongside 27538.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the fracture site by name (intercondylar spine, tibial tuberosity, or both), documents whether manipulation was performed, records the closed approach explicitly, and logs the provider's assumption of follow-up care. That specificity prevents downcoding to a nonspecific knee fracture code and blocks erroneous upcoding flags to 27540.

See how Mira captures CPT 27538 documentation