Surgical arrest of the distal femoral or proximal/distal tibial and fibular growth plates to equalize leg length discrepancy in a skeletally immature patient.

Verified May 8, 2026 · 6 sources ↓

Medicare: $730.48
Work RVU: 10.36
Global, days: 90
Region: Foot & ankle

Drawn from CMSBedrockbillingAAPCAAOSAcgme

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify which physis or physes were treated (distal femur, proximal tibia, distal tibia, fibula) by anatomic name.
Document the technique used: open, percutaneous drilling, staple, or screw-based epiphysiodesis.
Record the patient's bone age (skeletal age from left-hand radiograph or equivalent) and chronological age at time of surgery.
Include pre-operative leg length discrepancy measurement with method (scanogram, EOS, CT scout) and projected discrepancy at skeletal maturity.
State the clinical rationale and timing rationale — why this bone age was selected for intervention.
Document laterality for all physes addressed and note whether the procedure was unilateral or bilateral.

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 50 Bilateral procedure 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 AS PA/NP/CNS assistant LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27742 covers epiphysiodesis of the leg — a growth-plate arrest procedure performed on the tibia, fibula, and/or distal femur in pediatric patients with leg length discrepancy (LLD). The goal is to slow or stop growth on the longer limb so the shorter limb can catch up by skeletal maturity. Timing is everything: the surgeon works backward from projected adult height and remaining growth to schedule the procedure at the correct bone age. Operative notes must specify which physis or physes were addressed and the technique used (open, percutaneous drill, staple, or screw-based).

The 90-day global period covers all routine post-op visits, wound checks, and hardware surveillance imaging ordered as part of standard follow-up. Growth monitoring visits that involve new clinical decision-making — such as reassessing LLD progression or planning a subsequent procedure — can be billed separately with modifier 24. Contralateral procedures performed at the same session require modifier 50 or laterality modifiers LT/RT if staged.

Not all payers recognize pediatric orthopedic volume from PUF data, which reflects limited Medicare utilization; commercial and Medicaid payers are the primary reimburse for this procedure. Verify prior authorization requirements and medical necessity criteria with each payer, as LLD threshold (typically ≥2 cm projected discrepancy) and imaging requirements vary.

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 (10.36) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (21.87) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	10.36
Practice expense RVU	9.31
Malpractice RVU	2.2
Total RVU	21.87
Medicare national rate	$730.48
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	$730.48
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 27742 get rejected.

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

Missing bone-age documentation — payers require skeletal maturity data to establish medical necessity for growth arrest timing.
Projected LLD not documented or below the payer's minimum threshold (commonly ≥2 cm) in the operative or pre-op note.
Operative note specifies only 'standard approach' without naming which physis was arrested or technique employed.
Bilateral procedure billed without modifier 50 or without LT/RT modifiers, triggering duplicate-claim edits.
Post-op growth monitoring visits billed without modifier 24, denied as included in the 90-day global package.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Which physes does 27742 cover — can I use it for distal femur arrest alone?

27742 applies to epiphysiodesis of the tibia, fibula, and distal femur growth plates. Distal femur arrest alone or in combination with tibial/fibular arrest is reported with this code. Document exactly which physes were addressed in the operative note.

02If I perform bilateral epiphysiodesis in the same session, how do I bill?

Report 27742 with modifier 50 for a true bilateral same-session procedure, or use LT and RT on separate line items depending on your payer's preference. Some commercial payers require separate lines with LT/RT rather than modifier 50 — confirm before submitting.

03Can I bill a growth-monitoring visit during the 90-day global?

Routine surveillance is bundled into the 90-day global. If the visit involves new decision-making — such as assessing whether a second procedure is needed or managing an unrelated condition — bill the E/M with modifier 24 and document the distinct medical necessity.

04What ICD-10 codes support medical necessity for 27742?

M21.761/M21.762 (unequal limb length, right/left tibia) and related leg length discrepancy codes are the primary supports. Growth disturbance codes (M89.2x series) and acquired deformity codes may also apply depending on etiology. Confirm payer-specific covered diagnosis lists — LLD threshold requirements vary.

05If hardware is later removed, what code applies and does modifier 78 or 79 apply?

Hardware removal after epiphysiodesis within the global period uses the appropriate removal code with modifier 78 if the removal is a direct consequence of the original procedure (e.g., broken staple causing symptoms), or modifier 79 if it's a planned elective removal unrelated to a complication. Planned removal at skeletal maturity is typically modifier 79.

06Is prior authorization typically required for 27742?

Most commercial and Medicaid payers require prior authorization for elective pediatric orthopedic surgery including epiphysiodesis. Submit the LLD measurement, bone age study, projected discrepancy calculation, and clinical rationale with the auth request to avoid delays.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the specific physis or physes arrested, the surgical technique (percutaneous drill, staple, or screw), bone age at time of surgery, pre-operative LLD measurement and projection method, and laterality from the operative dictation. That specificity prevents the two most common denials for 27742: missing bone-age documentation and vague operative notes that omit which growth plate was targeted.

See how Mira captures CPT 27742 documentation