Surgical cutting and realignment of the tibia to correct angular deformity or redistribute joint load, performed through an open incision with fixation as indicated.

Verified May 8, 2026 · 6 sources ↓

Medicare: $692.73
Total RVUs: 20.74
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCAbosOptumcoding

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify the level of the osteotomy — shaft, diaphysis, or other tibial segment — and distinguish from proximal tibia or tibial tubercle procedures
Document the indication by name: unicompartmental arthritis, genu varum, genu valgum, or other deformity with supporting imaging measurements
Record fixation method used: plate and screws, external fixator, bone graft, or no fixation, as this affects medical necessity justification
Operative note must name the surgical approach and confirm the fibula was NOT cut if billing 27705 alone rather than 27709
Pre-operative weight-bearing alignment X-rays or long-leg films documenting the mechanical axis deviation should be in the record
Document failure of conservative management (PT, bracing, injections) prior to surgical intervention

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 58 Staged or related 59 Distinct service 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side 50 Bilateral procedure AS PA/NP/CNS assistant 80 Assistant surgeon

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27705 covers an osteotomy of the tibia — an open procedure in which the surgeon cuts the shinbone to correct alignment, address deformity, or shift mechanical load away from a damaged compartment. Common indications include unicompartmental knee arthritis in younger active patients, genu varum (bowleg), or genu valgum (knock-knee) deformity. The cut tibia is repositioned and typically secured with plates, screws, or a bone graft construct before closure.

This code sits in the 90-day global period, meaning all routine postoperative management through day 90 is bundled — no separate E/M visits during that window unless you append modifier 24. Note that 27705 describes a general tibial osteotomy of the shaft or diaphysis. Proximal tibial osteotomies correcting varus or valgus deformity (including fibular excision or osteotomy) are captured by 27455 or 27457 depending on epiphyseal status. The Fulkerson tibial tubercle transfer goes to 27418, not 27705. When both tibia and fibula are cut in the same session, report 27709 instead.

Payer-specific bundling edits apply: at least one payer has argued 27705 is a component of 27724; if you encounter that edit, document the distinct clinical necessity and appeal with operative note specifics. Modifier 51 is required when 27705 is billed alongside other surgical procedures on the same date of service.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.59
Practice expense RVU	8.19
Malpractice RVU	1.96
Total RVU	20.74
Medicare national rate	$692.73
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	$692.73
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,157.52

Common denial reasons

The recurring reasons claims for CPT 27705 get rejected.

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

Wrong code selected — Fulkerson tibial tubercle transfer billed as 27705 instead of 27418
Bundling edit applied when 27705 is billed same-day as 27724 without documentation of distinct procedural service
Proximal tibial osteotomy with fibular involvement submitted as 27705 instead of 27455 or 27457, triggering a code-specific denial
Missing modifier 51 when 27705 is billed alongside other same-session surgical procedures
Insufficient documentation of conservative treatment failure, causing medical necessity denial for elective realignment in older patients

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01When should I use 27709 instead of 27705?

Use 27709 when both the tibia and fibula are cut in the same operative session. If only the tibia is cut, 27705 is correct. If only the fibula is cut, use 27707.

02Can I bill 27705 for a Fulkerson tibial tubercle transfer?

No. The Fulkerson procedure — anteromedial tibial tubercle transfer — maps to 27418. Although it is technically an osteotomy, 27418 more accurately describes the tubercle transfer work and will survive audit scrutiny; 27705 will not.

03Can I bill 27705 for a proximal tibial osteotomy correcting varus or valgus deformity?

No. Proximal tibial osteotomy with fibular excision or osteotomy for genu varum or genu valgus correction is reported with 27455 (before epiphyseal closure) or 27457 (after epiphyseal closure). 27705 is reserved for tibial osteotomy that does not meet those more specific descriptors.

04What modifiers are required when 27705 is billed with another surgery on the same day?

Append modifier 51 to 27705 (the lower-valued procedure) when it is performed in the same session as another surgical procedure. If the second procedure is at a distinct anatomical site with separate documentation, modifier 59 may also be needed to bypass bundling edits.

05How does the 90-day global period affect billing after a tibial osteotomy?

Routine follow-up visits, wound checks, and stitch removals through postoperative day 90 are all bundled. To bill a separate E/M during the global, append modifier 24 (unrelated condition) or modifier 78 if the patient returns to the OR for a related complication.

06A payer is denying 27705 as a component of 27724. How should I respond?

This is a payer-specific bundling edit, not an NCCI standard. Respond with the operative note demonstrating the distinct clinical indication and surgical work of the tibial osteotomy, and request the payer cite their specific policy. Modifier 59 may be appropriate if the procedures are truly distinct and the note supports it.

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 level of the tibial cut, the angular correction achieved, fixation hardware used, and whether the fibula was addressed — the four documentation elements auditors check first on 27705 claims. That specificity prevents downcoding to a less-valued code and shuts down bundling edits that rely on vague operative language.

See how Mira captures CPT 27705 documentation