Surgical · Foot & ankle

27713

Tibial osteotomy performed using an intramedullary lengthening device to correct deformity or leg length discrepancy

Verified May 8, 2026 · 5 sources ↓

Medicare
$1,753.88
Total RVUs
52.51
Global, days
90
Region
Foot & ankle
Drawn from CMSAAOS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

  • Operative note must name the specific intramedullary lengthening device used (manufacturer and model), not just 'IM nail'
  • Pre-operative imaging (full-length standing radiographs) documenting the measured leg length discrepancy or angular deformity
  • Documented osteotomy site and technique — cortical cuts, corticotomy vs. full osteotomy — auditors flag generic 'standard approach' language
  • Distraction protocol documented or referenced, including planned rate and rhythm of lengthening
  • ICD-10 diagnosis code with laterality that matches the operative side and corresponds to the documented clinical indication
  • Informed consent noting the intramedullary approach, device type, and anticipated lengthening goal

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 62 Co-surgeons 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 5 cited references ↓

CPT 27713 describes an osteotomy of the tibia in which an intramedullary lengthening device — a motorized or mechanically actuated nail — is used to gradually distract the cut bone segments over time. The procedure addresses leg length discrepancy or angular deformity of the tibial shaft. Unlike traditional external fixator-based lengthening, the intramedullary approach keeps the distraction hardware entirely internal, which changes both the operative complexity and the post-operative management trajectory.

The 90-day global period covers the surgery, the day-before visit, and all routine post-op care through day 90 — including device adjustments that are considered routine follow-up. Separate E/M visits during the global window require modifier 24 if unrelated to the original procedure. Fluoroscopic guidance used intraoperatively is typically bundled; confirm payer policy before billing imaging codes separately.

Site of service matters significantly here. HOPD and ASC payment rates differ substantially — see the site-of-service comparison table on this page. Most payers require prior authorization given the high RVU weight and implant cost. Diagnosis coding must clearly support the indication: leg length discrepancy (ICD-10 Q72.8x, M21.0x) or post-traumatic deformity (M21.8x) are the most defensible.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU28
Practice expense RVU19.31
Malpractice RVU5.2
Total RVU52.51
Medicare national rate$1,753.88
Global period90 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

SettingMedicare rate (national)
Office (PFS non-facility)
Procedure performed in physician's office
$1,753.88
HOPD (APC 5114)
Hospital outpatient department
$7,413.38
ASC (PI J8)
Ambulatory surgical center (freestanding)
$4,682.29

Common denial reasons

The recurring reasons claims for CPT 27713 get rejected.

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

  • Missing or non-specific diagnosis: payer denies when ICD-10 lacks laterality or does not clearly document the degree of discrepancy justifying surgery
  • Prior authorization not obtained or obtained for a different procedure code (e.g., standard tibial osteotomy without IM device)
  • Operative note fails to distinguish intramedullary lengthening device from a standard locked IM nail — payer downcodes to lower-complexity osteotomy
  • Bundling conflict when intraoperative fluoroscopy is billed separately without confirming payer unbundling policy
  • Global period violations: routine device-check visits billed without modifier 24 or billed as related care that should be included in global

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What distinguishes 27713 from a standard tibial osteotomy code like 27705?
27713 specifically requires the use of an intramedullary lengthening device — a motorized or mechanically driven nail designed for gradual distraction. 27705 covers a standard tibial osteotomy without that device. If you used an intramedullary lengthening nail, bill 27713. If the operative note doesn't name the device, the payer will likely pay the lower-complexity code.
02Can I bill separately for intraoperative fluoroscopy with 27713?
Intraoperative fluoroscopy is generally bundled into the surgical procedure under NCCI policy for musculoskeletal cases. Some payers allow separate billing with modifier 59 or XS if fluoroscopy was performed at a distinct time or for a distinct purpose — verify the specific payer's policy before unbundling.
03What modifiers are needed when 27713 is performed bilaterally?
Bill 27713 twice — once with modifier LT and once with modifier RT. Do not use modifier 50 (bilateral) for inpatient or ASC claims unless the payer specifically requires it; LT/RT is the preferred approach for most Medicare and commercial payers on bilateral same-session tibial procedures.
04Is modifier 22 supportable if the lengthening was unusually complex?
Yes, but it requires documentation. The operative note must specifically describe what made the case substantially more complex than typical — prior hardware removal, prior infection, severe deformity requiring intraoperative replanning. Attaching a cover letter to the claim explaining the increased work is standard practice; expect a 20–30% withhold until the payer reviews.
05What ICD-10 codes are most defensible for authorizing 27713?
Leg length discrepancy codes (Q72.8x for congenital, M21.0x for acquired) and post-traumatic tibial deformity (M21.8x) are the most commonly accepted. The code must carry laterality. Payers will cross-check the auth diagnosis against the claim diagnosis — a mismatch is an automatic denial.
06What happens to device adjustment visits during the 90-day global period?
Routine device adjustment visits — activating the lengthening nail, confirming distraction rate, reviewing radiographs — are included in the 90-day global and cannot be billed separately. If the patient presents during the global period for a completely unrelated condition, bill the E/M with modifier 24 and document the unrelated nature clearly in the note.

Sources & references

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

  1. 01CMS Physician Fee Schedule 2026
  2. 02
    cms.gov
    https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-procedure-procedure-ptp-edits
  3. 03
    cms.gov
    https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-policy-manual
  4. 04
    aaos.org
    https://www.aaos.org/quality/coding-and-reimbursement/
  5. 05
    aaos.org
    https://www.aaos.org/education/about-aaos-products/coding-resources/

Mira AI Scribe

Mira's AI scribe captures the device manufacturer and model name, osteotomy site, corticotomy technique, and the planned distraction rate directly from surgeon dictation. It also flags laterality and links it to the pre-op imaging findings documented in the note. This prevents the most common downcoding trigger — an operative note that describes a standard IM nail rather than a lengthening device — and ensures the diagnosis code carries the laterality payers require for authorization matching.

See how Mira captures CPT 27713 documentation

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