Open fixation of a tibial shaft fracture using plate and screw constructs, with or without cerclage wires, and with or without an associated fibular fracture.
Verified May 8, 2026 · 6 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 6 cited references ↓
- Confirm open surgical approach is documented — this is not a closed or percutaneous technique
- Specify plate type, screw count, and construct configuration (e.g., locking vs. non-locking plate)
- Note whether cerclage wires were placed and document their purpose if used
- Document presence or absence of an associated fibular fracture and confirm it was not separately treated
- Record fracture pattern, location along the tibial shaft, and degree of displacement or comminution
- Identify operative limb (left or right) for modifier LT/RT application
- Include intraoperative fluoroscopy findings confirming fracture reduction and hardware placement
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 6 cited references ↓
27758 covers open treatment of a tibial shaft fracture stabilized with a plate-and-screw construct. Cerclage wires may be added for additional rotational control. If a fibular fracture is also present, it is not coded or billed separately — the procedure addresses the tibia only, and any fibular work is considered incidental.
The 90-day global period means all routine postoperative care — wound checks, suture removal, cast changes, and fracture follow-up visits — is bundled through day 90. An E/M visit for a new, unrelated problem during that window requires modifier 24. A decision-for-surgery visit made the day of or day before the index procedure requires modifier 57 on the E/M code.
27758 (plate/screws) and 27759 (intramedullary nail) are mutually exclusive — NCCI bundles them together. Do not bill both for the same tibial shaft fracture regardless of what hardware was used at different stages. The operative note must clearly distinguish the fixation method to justify whichever code is selected.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 12.23 |
| Practice expense RVU | 10.15 |
| Malpractice RVU | 2.57 |
| 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 5115) Hospital outpatient department | $13,116.76 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $8,872.72 |
Common denial reasons
The recurring reasons claims for CPT 27758 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Bundling edit triggered when 27758 and 27759 are billed together for the same tibial shaft fracture
- Missing laterality — claim submitted without modifier LT or RT, flagged for specificity
- E/M visit billed during the 90-day global period without modifier 24 or 57, denied as bundled
- Operative note documents intramedullary nail fixation but 27758 (plate/screws) is coded — mismatched hardware
- Modifier 22 used without supporting documentation detailing the substantially increased operative work
- Fibular fracture coded separately with a second procedure code, triggering a bundling denial
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01Can I bill 27758 and 27759 together if both a plate and a nail were used?
02Do I need to code the fibular fracture separately if it was also present?
03Which modifier applies when the surgeon makes the decision for surgery on the same day as the operation?
04When is modifier 22 appropriate for 27758?
05Is 27758 billed at the HOPD rate or ASC rate, and does it matter for the practice?
06What ICD-10 codes pair with 27758?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02aapc.comhttps://www.aapc.com/codes/cpt-codes/27758
- 03aapc.comhttps://www.aapc.com/codes/cpt-codes/27759
- 04mdclarity.comhttps://www.mdclarity.com/cpt-code/27758
- 05aaos.orghttps://www.aaos.org/globalassets/quality-and-practice-resources/coding-and-reimbursement/resident-guide/resident-guide_modifiers.pdf
- 06aoassn.orghttps://www.aoassn.org/wp-content/uploads/2020/12/CodingTTP.pdf
Mira AI Scribe
Mira's AI scribe captures the fixation method (plate and screws vs. IM nail), cerclage wire use, fibular fracture status and whether it was independently addressed, operative limb laterality, and fracture pattern from dictation. This prevents the most common audit flag for 27758 — operative notes that describe hardware inconsistent with the billed code — and supports modifier 22 when dictated complexity justifies it.
See how Mira captures CPT 27758 documentation