Tibial shaft fracture treated by intramedullary nail insertion, with or without interlocking screws and/or cerclage wire, regardless of concurrent fibular fracture.

Verified May 8, 2026 · 5 sources ↓

Medicare: $918.19
Total RVUs: 27.49
Global, days: 90
Region: Foot & ankle

Drawn from AAPCAMAMdclarityCMS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Fracture classification and location within tibial shaft (proximal, mid, distal third)
Operative note explicitly identifies IM nail insertion, reaming technique, and any interlocking screws or cerclage applied
If fibular fracture is present, document that it was not treated separately and explain why 27759 encompasses it
Laterality documented (left vs. right tibia) to support LT or RT modifier
Fluoroscopy or imaging guidance usage documented if separately billable
Anesthesia type and ASA classification noted for facility billing alignment
Post-op alignment and implant position confirmed via intraoperative imaging, referenced in the note

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 58 Staged or related 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side 50 Bilateral procedure 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 27759 covers intramedullary nailing of a tibial shaft fracture — the surgeon makes a proximal incision near the knee, reams the medullary canal, drives a rod through the full length of the tibia, and locks it with interlocking screws proximally and distally. Cerclage wiring may also be applied. The code explicitly encompasses concurrent fibular fractures: if a fibular fracture is present and treated as part of the same operative episode, you do not separately bill fibular fracture codes such as 27784. The 'with or without fibular fracture' language in the code descriptor swallows any associated fibula treatment performed through the same approach or separately.

The 90-day global period governs all post-op care. That window covers fracture checks, cast changes, wound care, and routine hardware monitoring through day 90. Unrelated conditions or new injuries billed during that window require modifier 24 (E/M) or 79 (unrelated procedure). A staged revision or unplanned return to the OR for the same fracture site uses modifier 78. Per AMA CPT Assistant guidance, intramedullary nailing is classified as open treatment regardless of whether the fracture site itself is directly visualized — because the fixation device is placed through a remote surgical exposure.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	14.09
Practice expense RVU	10.43
Malpractice RVU	2.97
Total RVU	27.49
Medicare national rate	$918.19
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	$918.19
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$8,846.34

Common denial reasons

The recurring reasons claims for CPT 27759 get rejected.

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

Separate billing of fibular fracture code 27784 alongside 27759 — the fibula is bundled into 27759's descriptor
Missing or incorrect laterality modifier (LT/RT) causing claim rejection on payers that mandate laterality for unilateral limb procedures
Post-op services billed without modifier 24 or 79 during the 90-day global period
Upcoding or downcoding due to confusion between 27759 (IM nail) and 27758 (open plate/screw fixation) — the implant type drives code selection
Facility site-of-service mismatch when procedure shifts from planned HOPD to ASC without updating the place-of-service code

Frequently asked questions

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

01Can I separately bill for fibular fracture treatment when 27759 is the primary code?

No. The descriptor explicitly covers tibial shaft fracture with or without fibular fracture. Per AMA CPT Assistant guidance, any fibular fracture treatment performed in the same operative setting — even through a separate incision — is included in 27759. Do not separately report 27784.

02What modifier do I use if the patient returns to the OR for hardware failure during the 90-day global?

Use modifier 78 — unplanned return to the operating room for a related procedure during the global period. If the return is for a completely unrelated condition, use modifier 79 instead.

03What distinguishes 27759 from 27758?

27758 covers open tibial shaft fracture treatment using plates and screws. 27759 is specifically for intramedullary implant fixation (nailing). The implant type — not the fracture pattern or severity — determines which code applies.

04Is 27759 considered open treatment even if the fracture site isn't directly visualized?

Yes. Per AMA CPT musculoskeletal guidelines, intramedullary nailing qualifies as open treatment because the fixation device is placed through a surgical exposure remote from the fracture site, even without direct fracture visualization.

05Do I need laterality modifiers on 27759?

Yes for payers that require them — append LT or RT. Many commercial payers and Medicare Advantage plans will reject unilateral limb procedure claims without laterality. Bilateral tibia nailing (rare but possible in polytrauma) uses modifier 50.

06Can 27759 be billed with an E/M on the same day?

Only the decision-for-surgery E/M on the day before or day of surgery survives using modifier 57. A separate E/M on the day of surgery for an unrelated condition requires modifier 25 on the E/M.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the nail brand and size, reaming sequence, interlocking screw count and configuration, cerclage application, fluoroscopic confirmation steps, and the status of any concurrent fibular fracture from the surgeon's dictation. That detail prevents the two most common audit flags for 27759: operative notes that omit implant specifics and notes that fail to address a co-documented fibular fracture — both of which invite separate fibula code scrutiny and medical necessity challenges.

See how Mira captures CPT 27759 documentation