Open repair of tibial nonunion or malunion using a sliding bone graft technique
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $833.35
- Total RVUs
- 24.95
- 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 5 cited references ↓
- Operative note must name the graft technique explicitly — 'sliding bone graft' not just 'bone graft' or 'graft used'
- Confirm nonunion or malunion diagnosis with pre-op imaging (X-ray, CT) showing failed healing or deformity
- Document the tibial segment(s) involved and the nature of the deformity or nonunion being corrected
- If modifier 22 is appended, include a separate statement of increased complexity with estimated additional operative time
- For global-period return visits, document whether the issue is related or unrelated to the index procedure to support modifier 78 vs. 79
- Dictate fixation method used (plate, nail, screws) and intraoperative fluoroscopy findings if applicable
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 5 cited references ↓
CPT 27722 covers open surgical repair of a tibial nonunion or malunion using a sliding bone graft — where a cortical segment is shifted from adjacent bone rather than harvested from a separate donor site. This distinguishes it from 27720 (repair without graft) and 27724 (repair with iliac or other autograft requiring a separate harvest). Selecting the wrong code in this family is a common audit trigger; the operative note must name the graft technique explicitly.
The 90-day global period means all routine follow-up through day 90 is bundled. Any fracture-related return to the OR within that window requires modifier 78 (unplanned, related procedure). An unrelated procedure in the global period requires modifier 79. Billing E/M visits for routine post-op management in the global window without modifier 24 will deny.
Site of service matters here. HOPD and ASC payments differ substantially — see the site-of-service comparison table on this page. For bilateral tibial procedures on the same date, modifier 50 applies. If a significantly more complex repair is performed (e.g., extensive hardware removal, correction of severe angular deformity), modifier 22 with supporting documentation of increased complexity is appropriate.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 12.14 |
| Practice expense RVU | 10.22 |
| Malpractice RVU | 2.59 |
| Total RVU | 24.95 |
| Medicare national rate | $833.35 |
| 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 | $833.35 |
HOPD (APC 5114) Hospital outpatient department | $7,413.38 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $4,737.67 |
Common denial reasons
The recurring reasons claims for CPT 27722 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Graft type not specified in operative note — payer cannot distinguish 27722 from 27720 or 27724
- Routine post-op E/M billed without modifier 24 inside the 90-day global period
- Missing pre-op imaging documentation establishing nonunion or malunion diagnosis
- Modifier 78 vs. 79 inverted on a same-global return to OR — modifier 79 used for a clearly related complication
- Bilateral procedure submitted without modifier 50 or separate LT/RT line items per payer requirement
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01What separates 27722 from 27720 and 27724?
02Can I bill a separate code for the bone graft harvest with 27722?
03How does the 90-day global period affect billing for complications?
04Is pre-authorization typically required for 27722?
05Can 27722 be billed with hardware removal codes on the same date?
06Does site of service affect payment for 27722?
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/national-correct-coding-initiative-ncci
- 03cms.govhttps://www.cms.gov/files/document/chapter1generalcorrectcodingpoliciesfinal11.pdf
- 04findacode.comhttps://www.findacode.com/cpt/27722-cpt-code.html
- 05aapc.comhttps://www.aapc.com/codes/cpt-codes/27722
Mira AI Scribe
Mira's AI scribe captures the graft technique by name from dictation — sliding cortical graft, harvest site if separate, fixation construct, and intraoperative reduction quality. It flags operative notes that use generic language like 'bone graft applied' without specifying the sliding technique, which is the primary reason auditors downcode 27722 to 27720 or query for 27724.
See how Mira captures CPT 27722 documentation