Open reduction and internal fixation of intercondylar or transcondylar knee fractures, including tibial tubercle fractures requiring surgical stabilization.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $762.54
- Total RVUs
- 22.83
- 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 6 cited references ↓
- Operative note must name the specific fracture pattern (intercondylar, transcondylar, tibial tubercle avulsion) — not just 'proximal tibia' or 'distal femur'
- Document the open reduction technique: approach used, visualization of fracture, method of reduction
- Specify internal fixation construct: screw type and count, plate system, tension band wire, or combination
- Preoperative imaging (X-ray and/or CT) confirming fracture pattern and displacement must be in the record
- Intraoperative fluoroscopy documentation or C-arm confirmation of reduction and hardware position
- Post-reduction X-ray with hardware position noted in the operative note or radiology report
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 6 cited references ↓
CPT 27540 covers open reduction with internal fixation of intercondylar and transcondylar fractures of the knee — including tibial tubercle avulsion fractures. The code applies when the surgeon opens the fracture site, reduces the fragment(s), and stabilizes them with hardware (screws, plates, tension band constructs, or similar). It does not apply to tibial plateau fractures, which fall under 27535 or 27536 depending on complexity.
The 27540 vs. 27535 distinction trips up coders and ASCs alike. If the fracture involves the tibial plateau surface, use the plateau codes. If it involves the intercondylar eminence, condylar fracture patterns crossing the joint, or the tibial tubercle apophysis, 27540 is the correct selection. Operative note specificity on fracture location is what survives an audit — vague references to 'distal femur' or 'proximal tibia' without naming the fracture pattern will draw scrutiny.
The 90-day global period starts the day of surgery. Routine follow-up visits, hardware monitoring x-rays ordered as part of fracture care, and any fracture-related wound checks through day 90 are bundled. Complications requiring a return to the OR for a related procedure (hardware failure, wound dehiscence requiring operative intervention) bill under modifier 78. An unrelated procedure in the same window uses modifier 79.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 11.02 |
| Practice expense RVU | 9.48 |
| Malpractice RVU | 2.33 |
| Total RVU | 22.83 |
| Medicare national rate | $762.54 |
| 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 | $762.54 |
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 27540 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Wrong code selected — payer downcodes to 27535 when operative note describes tibial plateau involvement without clearly differentiating intercondylar or tubercle fracture
- Missing fracture pattern specificity in the operative note; audit teams flag notes that don't name the fracture type and location explicitly
- Global period violation — post-op E/M visits billed without modifier 24 for a clearly related complaint during the 90-day window
- Bundling conflicts when fluoroscopy (77002) is billed separately without confirming payer allows unbundling for fracture fixation
- Incorrect modifier usage on a return to OR — modifier 78 omitted when the same-session or post-op complication procedure is related to the original fracture repair
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What separates 27540 from 27535 and 27536?
02Can 27540 and 27535 be billed together on the same surgical encounter?
03What does the 90-day global period include for 27540?
04How should a return to the OR for a broken screw or hardware failure be billed?
05Is fluoroscopy billable separately with 27540?
06When is modifier 22 appropriate for 27540?
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/medicare/regulations-guidance/physician-self-referral/list-cpt-hcpcs-codes
- 03cms.govhttps://www.cms.gov/files/document/01-chapter1-ncci-medicare-policy-manual-2025finalcleanpdf.pdf
- 04cms.govhttps://www.cms.gov/medicare/coding-billing/ncci-medicaid/medicaid-ncci-policy-manual
- 05aapc.comhttps://www.aapc.com/codes/cpt-codes/27535
- 06aaos.orghttps://www.aaos.org/education/about-aaos-products/coding-resources/
Mira AI Scribe
Mira's AI scribe captures the fracture pattern name, anatomic location (intercondylar, transcondylar, or tibial tubercle), reduction technique, approach, and fixation construct from the surgeon's dictation. This prevents the most common audit trigger for 27540 — operative notes that describe hardware placement without documenting the specific fracture type that separates 27540 from 27535 or 27536.
See how Mira captures CPT 27540 documentation