Open repair of tibial nonunion or malunion without bone graft, performed to correct improper healing and restore function.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $811.31
- Total RVUs
- 24.29
- Global, days
- 90
- Region
- Foot & ankle
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 6 cited references ↓
- Operative report must explicitly state nonunion or malunion of the tibia — not just 'fracture repair'
- Imaging (X-ray, CT) confirming failed healing or malalignment, dated prior to surgery
- Laterality documented in both the operative note and the diagnosis code
- Confirmation that no bone graft was harvested or placed — if graft used, code to 27722 instead
- Description of surgical approach and fixation technique used at the nonunion/malunion site
- Prior treatment history documenting the original fracture and any prior repair attempts
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 27720 covers open surgical repair of a tibia that has failed to heal correctly — either a nonunion (no healing) or malunion (healed in a poor position) — without the use of a bone graft. The surgeon addresses the pathologic union site directly to restore alignment and function. When a graft is required, the correct code is 27722, not 27720.
The 90-day global period means all routine postoperative care from the day of surgery through day 90 is bundled into the payment. Separate E/M visits within that window require modifier 24 to indicate an unrelated problem, or modifier 79 for an unrelated procedure requiring a return to the OR. An unplanned return to address a complication of the original tibial repair uses modifier 78.
Not all payers treat nonunion repair identically. Commercial carriers may require preauthorization and supporting imaging evidence of nonunion or malunion. ICD-10 diagnosis coding must distinguish nonunion from malunion and identify laterality — mismatched or nonspecific diagnosis codes are a primary claim rejection trigger for this procedure.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 12.05 |
| Practice expense RVU | 9.83 |
| Malpractice RVU | 2.41 |
| Total RVU | 24.29 |
| Medicare national rate | $811.31 |
| 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 | $811.31 |
HOPD (APC 5114) Hospital outpatient department | $7,413.38 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $4,845.90 |
Common denial reasons
The recurring reasons claims for CPT 27720 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- ICD-10 code reflects acute fracture rather than nonunion or malunion, triggering medical necessity mismatch
- Missing laterality in the diagnosis code — nonspecific tibial nonunion codes are frequently flagged
- Claim submitted without preauthorization when commercial payer requires it for nonunion repair
- 27720 and 27722 billed together for the same tibia on the same date — only one repair code is payable per anatomic site
- Routine postoperative visit billed without modifier 24, denied under the 90-day global period
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What is the difference between 27720 and 27722?
02Can 27720 and 27722 be billed together for the same tibia?
03What modifier applies if the surgeon returns to the OR during the 90-day global to address a complication of the original tibial repair?
04Which ICD-10 codes are appropriate for 27720?
05Does 27720 carry a 90-day global period?
06Is preauthorization typically required for 27720?
07When is modifier 22 appropriate for 27720?
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/files/document/r13575cp.pdf
- 03cms.govhttps://www.cms.gov/files/document/04-chapter4-ncci-medicare-policy-manual-2026-final.pdf
- 04aapc.comhttps://www.aapc.com/codes/cpt-codes/27720
- 05cgsmedicare.comhttps://www.cgsmedicare.com/medicare_dynamic/j15/partb/ptpb/ptp.aspx
- 06aaos.orghttps://www.aaos.org/globalassets/quality-and-practice-resources/coding-and-reimbursement/resident-guide/resident-guide-coding-reference-tools_what-is-ncci-mue_050125.pdf
Mira AI Scribe
Mira's AI scribe captures the specific pathology (nonunion vs. malunion), confirms the absence of bone graft, records the surgical approach and fixation technique, and logs laterality — all from dictation. This prevents the most common denial trigger: a diagnosis code that says 'fracture' instead of 'nonunion' or 'malunion,' which forces a medical necessity rejection before the claim ever reaches adjudication.
See how Mira captures CPT 27720 documentation