Surgical repair of a fibula fracture that has failed to heal, performed with internal fixation to restore bony union and stability.

Verified May 8, 2026 · 8 sources ↓

Medicare: $875.10
Total RVUs: 26.2
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCBedrockbillingEmednyMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Specify nonunion vs. malunion (or both) in the operative note and diagnosis — payers require clarity on the pathology being addressed.
Document the interval since original fracture and prior treatment history (prior fixation, hardware removal, grafting attempts) to justify nonunion diagnosis.
Name the internal fixation construct used (plate and screws, intramedullary nail, etc.); notes that omit hardware type are audit targets.
If bone graft was obtained and used, document graft source (autograft iliac crest, allograft, synthetic) and technique — this may support additional coding.
Record the fibula level (shaft vs. distal) and any angular or rotational deformity corrected, as this affects code selection and supports modifier 22 if complexity is substantially increased.
Pre-operative imaging (X-ray or CT) confirming nonunion should be referenced in the operative note to support medical necessity.

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 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

CPT 27726 covers operative repair of a fibula nonunion and/or malunion using internal fixation — typically plates, screws, or intramedullary devices — applied after the original fracture failed to achieve solid union. The procedure may also involve bone grafting (autograft or allograft) to stimulate healing at the nonunion site, debridement of fibrous tissue at the fracture ends, and correction of any angular or rotational deformity present from malunion. The code applies to fibula shaft nonunions as well as distal fibula nonunions, provided internal fixation is performed; if no hardware is placed, modifier 52 is warranted per AAPC forum consensus.

Do not confuse 27726 with acute fibula fracture codes (e.g., 27784 for open treatment of proximal fibula or shaft fracture). Those codes cover initial fracture management; 27726 is specifically for the delayed, failed-healing scenario. Adjacent tibial nonunion work is captured separately under 27720–27725. The 90-day global period means all routine post-op visits, wound care, and hardware checks through day 90 are bundled — bill modifier 24 for unrelated E/M encounters and modifier 79 for unrelated procedures within that window.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	13.98
Practice expense RVU	9.46
Malpractice RVU	2.76
Total RVU	26.2
Medicare national rate	$875.10
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	$875.10
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,746.58

Common denial reasons

The recurring reasons claims for CPT 27726 get rejected.

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

Using an acute fracture code (e.g., 27784) instead of 27726 — payers reject the nonunion code when the claim date and injury date are too close together, or vice versa.
Missing nonunion diagnosis on the claim; ICD-10 must reflect nonunion (M84.36x series) rather than a routine fracture code to match 27726.
Billing a bone graft code bundled with 27726 without confirming NCCI edit status — some graft codes are bundled and require modifier 59/XS to separate.
Modifier 52 omitted when operative note documents no internal fixation was placed — payers may downcode or deny when hardware is absent and 52 is not appended.
Global period violations: routine post-op E/M billed without modifier 24, or a related return procedure billed without modifier 78, both trigger bundling denials.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01What is the difference between 27726 and 27784 for fibula fractures?

27784 covers open treatment of an acute proximal fibula or shaft fracture at the time of initial care. 27726 is used only when a prior fibula fracture has failed to heal — a nonunion — and surgical repair with internal fixation is now required. Applying 27784 to a nonunion case is a misuse and a common denial trigger.

02Should I append modifier 52 if no hardware was placed?

Yes. The code descriptor specifically references internal fixation. When the surgeon performs the nonunion repair without placing hardware (e.g., bone graft alone, excision of nonunion fragment), modifier 52 signals reduced services and aligns the claim with the operative report. Billing 27726 without modifier 52 in a no-hardware case invites a mismatch audit.

03Can bone grafting be billed separately with 27726?

It depends on graft type and NCCI edit status. Check Bedrock Billing or CMS NCCI tables for current column pairs before unbundling. If the graft code is not bundled, append modifier 59 or XS to identify it as a distinct service. Autograft harvest from the iliac crest has historically been separately reportable; confirm for your payer.

04What ICD-10 codes support 27726?

Nonunion of fracture is captured in the M84.36x series (fibula nonunion by laterality and level). Malunion uses M84.37x series. Using a routine closed fracture S-code on a claim for 27726 is a top denial cause — the diagnosis must confirm the nonunion or malunion pathology.

05How does the 90-day global period affect post-op billing for 27726?

The 90-day global bundles the day-before pre-op visit, the surgery day, and all routine post-op E/M through day 90. Unrelated E/M encounters need modifier 24. If the patient returns to the OR for a complication related to the original repair, use modifier 78. An unrelated OR procedure in the same window takes modifier 79. Missing these modifiers is the most common global-period denial.

06Is 27726 appropriate for distal fibula nonunion, or only shaft nonunions?

27726 applies to fibula nonunion at any level — shaft or distal — when internal fixation is performed. There is no separate nonunion code specific to the distal fibula. Document the anatomic level in the operative note; some payers and auditors flag notes that lack this specificity.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures fibula nonunion vs. malunion distinction, the specific fixation construct applied (plate, screws, nail), fibula level (shaft or distal), bone graft source and harvest technique if performed, and any deformity corrected. That dictation prevents the two most common denials for 27726: an ICD-10 mismatch between acute fracture and nonunion codes, and audit flags for operative notes that omit hardware details or fail to document prior treatment history establishing delayed union.

See how Mira captures CPT 27726 documentation