Surgical arrest of epiphyseal growth at both the proximal and distal tibia and fibula, performed to equalize leg lengths during skeletal development.

Verified May 8, 2026 · 5 sources ↓

Medicare: $667.35
Work RVU: 9.37
Global, days: 90
Region: Foot & ankle

Drawn from CMSFastrvuFindacodeAAPCAAOS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Bone age confirmed by radiograph (left hand/wrist standard), with date of study
Limb length discrepancy measurement method documented — scanogram, EOS, or CT scout — with measured values in centimeters
Growth-remaining estimate and predicted discrepancy at skeletal maturity, justifying timing of intervention
Operative note specifies surgical technique (open, percutaneous drill, staple, or screw) and confirms both proximal and distal physes of tibia and fibula were addressed
Pre-operative diagnosis linking ICD-10 leg length discrepancy code to clinical findings
Patient's chronological age and skeletal maturity status documented in the H&P

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 59 Distinct service LT Left side RT Right side 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 27740 describes combined epiphysiodesis of the tibia and fibula — a procedure that fuses growth plates at both ends of these bones to halt longitudinal growth and allow the contralateral limb to catch up. It is performed in skeletally immature patients with leg length discrepancy when the predicted overgrowth of the longer leg can be timed and corrected through growth arrest rather than lengthening. Techniques include open, percutaneous drill, stapling, or screw-based approaches; the code covers any method as long as both the proximal and distal physes of the tibia and fibula are addressed in the same operative session.

The 90-day global period applies. All routine follow-up — wound checks, staple or suture removal, cast changes, and standard post-op imaging interpretation — are bundled. Separate billing during the global window requires modifier 24 (unrelated E/M) or 79 (unrelated procedure). Because this is almost exclusively a pediatric procedure, payers may apply additional medical necessity criteria; document the patient's bone age, predicted adult height, limb length discrepancy measurement method (scanogram or EOS), and growth-remaining estimate explicitly in the record.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (9.37) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (19.98) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	9.37
Practice expense RVU	8.62
Malpractice RVU	1.99
Total RVU	19.98
Medicare national rate	$667.35
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	$667.35
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI G2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 27740 get rejected.

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

Medical necessity not established — missing growth-remaining analysis or scanogram measurements in the record
Skeletal maturity not documented — payers deny when bone age confirmation is absent from the pre-op workup
Incorrect procedure code selected — 27740 requires combined proximal AND distal arrest; unilateral or single-level epiphysiodesis maps to a different code
Global period conflict — post-op E/M billed without modifier 24 when visit was routine follow-up bundled into the 90-day global
Site-of-service mismatch — procedure billed under a facility code inconsistent with the place of service reported on the claim

Frequently asked questions

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

01Does 27740 cover epiphysiodesis of only one end of the tibia and fibula?

No. 27740 is specifically for combined proximal AND distal arrest of both the tibia and fibula in the same session. If only one physis level is addressed, this code does not apply — review the 27730 and 27735 code family for single-site arrest.

02Can 27740 be billed bilaterally with modifier 50?

Bilateral epiphysiodesis is rare but not impossible. If both legs are treated in the same operative session, append modifier 50 and confirm your payer's bilateral payment policy — some apply a 150% rule, others require separate line items with LT and RT.

03What ICD-10 codes support medical necessity for 27740?

M21.751 and M21.752 (unequal limb length, femur), M21.761 and M21.762 (unequal limb length, tibia), and Q72-series congenital limb deficiency codes are the primary supporting diagnoses. Pair the LLD code with any underlying etiology code when applicable.

04Is 27740 subject to a 90-day global period?

Yes. The 90-day global bundles the day-before pre-op visit, the operative session, and all routine follow-up through post-op day 90. Bill modifier 24 on unrelated E/M visits and modifier 79 on unrelated surgical procedures within that window.

05What if the surgeon also performs a corrective osteotomy in the same session?

Report the osteotomy code separately with modifier 51 (multiple procedures). Document distinctly why each procedure was medically necessary and that they addressed separate clinical objectives. Modifier 59 may be needed if NCCI bundles the codes.

06How does the HOPD vs. ASC payment difference affect site-of-service decisions for 27740?

Per the CMS Physician Fee Schedule 2026, the HOPD facility payment is substantially higher than the ASC payment. For a pediatric procedure typically requiring general anesthesia, confirm that the chosen facility can safely manage pediatric cases — clinical safety outweighs payment differential, but the gap is relevant to practice economics.

Sources & references

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

Mira Scribe

Mira's AI scribe captures bone age, limb length discrepancy values, growth-remaining estimate, and the specific surgical technique (percutaneous drill, staple, or screw) directly from dictation. That prevents the most common denial trigger for 27740 — a medical necessity rejection when the record lacks quantified LLD measurements and a documented rationale for procedural timing.

See how Mira captures CPT 27740 documentation