Surgical partial excision of the fibula bone, typically performed to remove diseased, damaged, or abnormal bone segment from the fibula shaft or its distal end.

Verified May 8, 2026 · 7 sources ↓

Medicare: $609.90
Total RVUs: 18.26
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCMdclarityCgsmedicareAAOS

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify the exact fibular segment resected — mid-shaft, proximal, or distal (lateral malleolus) — with measurements when possible.
Document the pathologic indication: osteomyelitis, tumor, fracture fragment, exostosis, or other abnormality requiring excision.
Describe the surgical technique: segmental resection vs. saucerization/curettage, and whether the periosteum was preserved.
Record the approach, wound closure method, and any intraoperative findings such as extent of bone involvement.
If concurrent procedures were performed (e.g., tenolysis, ligament repair), document each as a distinct service with its own indication and surgical steps.
For staged or planned subsequent procedures, document intent explicitly in the operative note to support modifier 58 on the return surgery.

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 57 Decision for surgery 58 Staged or related 59 Distinct service 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 27641 covers partial removal of the fibula — a procedure indicated for osteomyelitis, tumors, avulsion fracture fragments, or other fibular pathology requiring bone excision. The surgeon may resect a mid-shaft segment or curette diseased bone, leaving a saucer- or crater-shaped defect. The lateral malleolus is the distal fibula; excision of a fracture fragment from that site falls under 27641.

This code carries a 90-day global period. All routine post-op visits, wound care, and dressing changes through day 90 are bundled. An E/M billed in the global window requires modifier 24 (unrelated) or modifier 25 (same-day, significant and separately identifiable). If you know the patient will need a staged return procedure, document that intent in the operative note and bill the second procedure with modifier 58. An unplanned return to the OR for a related complication uses modifier 78; an unrelated procedure in the global period uses modifier 79.

NCCI bundles 27641 with certain tenolysis codes (e.g., 27680). If both procedures are genuinely distinct and performed through separate approaches or for separate indications, modifier 59 or an X-modifier can bypass that edit — but the operative note must support the distinctness. Bilateral fibular excision is unusual but possible; report with modifier 50 on a single claim line for Medicare Part B, or on separate lines with LT and RT in the ASC setting.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.59
Practice expense RVU	7.13
Malpractice RVU	1.54
Total RVU	18.26
Medicare national rate	$609.90
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	$609.90
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 27641 get rejected.

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

Bundling denial when 27641 is billed same-day with tenolysis code 27680 without a supporting modifier 59 or X-modifier and distinct documentation.
Global period violation — E/M billed within the 90-day post-op window without modifier 24 or 25, causing automatic denial.
Insufficient documentation of the pathologic indication; payers deny when the operative note lacks a clear diagnosis linking the bone excision to a covered condition.
Laterality missing — absence of LT or RT modifier triggers claim edits at many payers for unilateral extremity procedures.
Modifier 78 vs. 79 confusion: using 79 for a return related to the original procedure (or vice versa) results in denial or incorrect payment during the global period.

Frequently asked questions

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

01Does excision of a lateral malleolus fracture fragment map to 27641?

Yes. The lateral malleolus is the distal end of the fibula. If the operative note documents excision of a fracture fragment from the lateral malleolus, 27641-LT (or RT) is the correct code. Append the appropriate laterality modifier.

02Can 27641 and 27680 (tenolysis) be billed together?

They are NCCI-bundled, but the edit carries a modifier indicator of 1, meaning modifier 59 or an X-modifier can bypass it when the procedures are genuinely distinct — separate indications, separate tissue planes, or separate approaches. The operative note must make that distinction explicit.

03What global period applies to 27641, and what does it include?

27641 carries a 90-day global. Bundled into that global: the day-before visit, the surgery itself, and all routine post-op care through day 90. Unrelated E/M visits in that window need modifier 24; same-day significant E/M visits need modifier 25.

04When should modifier 22 be used with 27641?

Use modifier 22 when the resection required substantially more work than typical — for example, extensive osteomyelitic involvement requiring wider margins, complex reconstruction, or unusually prolonged operative time. Attach a cover letter quantifying the additional work and time; payers will request the operative note.

05How is a bilateral fibular excision reported under Medicare?

For Medicare Part B, report 27641-50 on a single claim line. In the ASC setting, report two lines — one with modifier LT and one with RT — each with one unit of service, per CMS NCCI billing guidelines.

06How does 27641 differ from 27640?

27640 covers partial excision of the fibula for conditions such as osteomyelitis or a bone cyst. 27641 covers a similar partial excision but is the code for diaphyseal fibular resection scenarios and certain other indications. Verify the specific CPT guidelines and your operative note against both descriptors — coding forums have noted confusion between the two, and the correct choice depends on the exact procedure performed.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the fibular segment location (mid-shaft, proximal, distal/lateral malleolus), resection technique (segmental vs. saucerization), pathologic indication, and any concurrent procedures with their individual surgical steps. That detail prevents the two most common audit flags for 27641: vague operative notes that don't justify the excision, and bundling denials when additional procedures lack documented distinctness.

See how Mira captures CPT 27641 documentation