Percutaneous skeletal fixation of a tibial shaft fracture, with or without an associated fibular fracture, using pins or screws placed through the skin under fluoroscopic guidance.

Verified May 8, 2026 · 5 sources ↓

Medicare: $564.48
Work RVU: 7.26
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCGenhealthIcdcodesOrthoInfo

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 specific fixation method (pins, screws) and confirm percutaneous — not open — technique
Fluoroscopic imaging confirmation of bone alignment and hardware placement intraoperatively
Fracture classification including open vs. closed status and Gustilo grade if open wound is present
Laterality explicitly documented — left, right, or bilateral — to support ICD-10 code selection
Pre-operative imaging (X-ray or CT) showing tibial shaft fracture with or without fibular involvement
Anesthesia type and patient positioning noted in the operative record

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 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

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 27756 describes percutaneous stabilization of a tibial shaft fracture — with or without concurrent fibular fracture — using hardware such as pins or screws driven through small skin incisions into the bone under live fluoroscopic imaging. No open dissection of the fracture site is performed; the percutaneous approach distinguishes this code from open reduction and internal fixation codes in the same family. The procedure is indicated when displacement or instability requires surgical stabilization but the fracture anatomy is amenable to closed or minimally invasive fixation rather than formal open exposure.

The 90-day global period covers the surgery date, the day-before visit if applicable, and all routine postoperative management through day 90. Any E/M service unrelated to tibial fracture care billed within that window requires modifier 24. A planned staged procedure — such as hardware exchange or conversion to intramedullary nailing — billed by the same surgeon in the global period requires modifier 58. Unplanned returns to the OR for an unrelated condition in the global window need modifier 79.

ICD-10 pairing must specify laterality, fracture type (open vs. closed), and encounter type. S82.20xA through S82.29xB cover shaft fractures by laterality and open/closed status at initial encounter. Audit teams flag claims where the ICD-10 encounter designator doesn't match the procedure date — initial encounter codes (A/B suffixes) must align with the operative claim, not a follow-up visit.

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 (7.26) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (16.9) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.26
Practice expense RVU	8.11
Malpractice RVU	1.53
Total RVU	16.9
Medicare national rate	$564.48
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	$564.48
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,452.27

Common denial reasons

The recurring reasons claims for CPT 27756 get rejected.

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

ICD-10 encounter suffix mismatch — using a subsequent encounter code (D suffix) on the operative claim instead of initial encounter (A or B)
Missing laterality in the diagnosis code, causing claim to reject for specificity
Bundling denial when a same-day fibular fixation code is billed without modifier 59 to establish distinct service
Global period conflict — E/M billed within the 90-day window without modifier 24 documenting unrelated condition
Insufficient documentation to support percutaneous technique; operative note describes open exposure, creating upcoding exposure

Frequently asked questions

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

01Does 27756 cover an associated fibular fracture treated in the same session?

The code descriptor explicitly includes 'with or without fibular fracture,' so an ipsilateral fibular fracture addressed percutaneously in the same session is bundled into 27756. If fibular fixation is performed as a distinct, separate procedure on the same day, modifier 59 is required to unbundle — and your operative note must support the distinct service claim.

02What's the difference between 27756 and 27758?

27756 is percutaneous fixation — hardware placed through the skin without open exposure of the fracture. 27758 is open treatment of a tibial shaft fracture with internal fixation. If your operative note describes any formal open dissection down to the fracture site, 27756 is the wrong code.

03Can you bill a cast application separately on the same day as 27756?

No. A splint or cast applied at the conclusion of percutaneous fixation is considered part of the procedure and is not separately reportable. Cast application codes are only separately billable when no definitive fracture care is performed on the same date.

04Which modifier applies if the same surgeon takes the patient back to the OR during the global period for intramedullary nailing due to fixation failure?

Use modifier 58. Conversion from percutaneous fixation to intramedullary nailing by the same surgeon within the 90-day global is a staged or related procedure. Modifier 78 applies only to unplanned returns for a complication directly related to the original procedure — not planned conversions.

05How should bilateral tibial shaft fractures be billed?

Bilateral tibial shaft fractures treated in the same operative session are billed with modifier 50 on 27756, or as two line items with RT and LT. Confirm your payer's preference — Medicare and most commercial payers accept modifier 50, but some Medicaid programs require separate line items. Bilateral tibial shaft fractures from a single traumatic event are uncommon; document the mechanism clearly.

06What ICD-10 code pairs with 27756 at the initial operative encounter?

Use codes from the S82.2xx series, which cover tibial shaft fractures. You need laterality (1 = right, 2 = left, 9 = unspecified) and encounter type (A = initial closed, B = initial open type I or II, C = initial open type IIIA/B/C). For example, S82.201A is an unspecified right tibial shaft fracture, initial encounter, closed. 'Unspecified' laterality is an audit flag — use it only when documentation genuinely doesn't specify.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the fixation method (pins vs. screws), percutaneous approach confirmation, fluoroscopy use, laterality, fracture classification (open/closed), and whether a concurrent fibular fracture was addressed — all from surgeon dictation. That prevents the two most common denials on this code: ICD-10 specificity rejections from missing laterality and downcoding audits triggered by operative notes that don't explicitly confirm the percutaneous technique.

See how Mira captures CPT 27756 documentation