Open surgical repair of a medial malleolus fracture with internal fixation as indicated.

Verified May 8, 2026 · 7 sources ↓

Medicare: $579.84
Work RVU: 7.69
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCAacpmAbosAoassn

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify open approach explicitly — do not document as 'standard approach' or leave approach unnamed in the operative note
Identify the fracture location as medial malleolus; distinguish from lateral (fibula), posterior, or multi-malleolar involvement
Document all implants used for fixation (screw type/size, plate system) to support implant billing and audit defense
Record fracture classification and displacement to justify surgical versus closed management
Note laterality (left vs. right) in both the operative report and the claim; required for LT/RT modifier assignment
If modifier 22 is used for increased complexity (e.g., comminution, revision, obesity), include a separate attestation of additional work and time in the operative note

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 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 7 cited references ↓

27766 covers open treatment of a medial malleolus fracture — the bony prominence on the inner side of the ankle — including internal fixation with screws, plates, or other hardware when performed. This is the correct code when the surgeon uses an open approach to reduce and stabilize the fracture; closed treatment without manipulation goes to 27760, and closed treatment with manipulation goes to 27762. If the fracture is treated with closed manipulation plus percutaneous fixation and no specific CPT code applies, report unlisted code 27899 with supporting documentation.

For multi-malleolar injuries, code selection depends on exactly which malleoli are operatively treated. Isolated medial malleolus ORIF = 27766. Add lateral malleolus fixation and the encounter upgrades to bimalleolar code 27814. Add a posterior malleolus and it becomes trimalleolar territory (27822–27823). Do not report 27766 and 27814 together for the same ankle — 27814 already includes medial fixation. For a 'bimalleolar equivalent fracture,' AMA guidance directs coders to report the individual malleolus codes (lateral or medial series) rather than the bimalleolar code.

The 90-day global period covers all routine follow-up care through day 90. Hardware removal, unrelated E/M visits, or new injuries in that window require modifier 24 (unrelated E/M), 78 (unplanned return to OR for related complication), or 79 (unrelated procedure in global period). Bilateral ankle fixation in one session is rare but would take modifier 50 with payer pre-authorization.

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 (7.69) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (17.36) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.69
Practice expense RVU	8.18
Malpractice RVU	1.49
Total RVU	17.36
Medicare national rate	$579.84
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	$579.84
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 27766 get rejected.

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

Missing or ambiguous laterality — claim submitted without LT or RT modifier triggers automatic rejection by many payers
Upcoding to bimalleolar code 27814 when only the medial malleolus was fixed — operative note must isolate the medial malleolus repair
Global period conflict — post-op E/M or procedure billed within 90 days without the required modifier (24, 78, or 79)
Bundling conflict when 27766 is billed alongside 27814 or 27822/27823 for the same ankle in the same session
Closed treatment code submitted (27760 or 27762) when the operative note documents an open incision and hardware placement

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01When does medial malleolus ORIF get coded as 27814 instead of 27766?

Use 27814 when both the medial and lateral malleoli (or medial and posterior, or lateral and posterior) are operatively fixed in the same session. 27766 is for isolated medial malleolus repair only. Do not report both codes for the same ankle.

02How do you code closed manipulation plus percutaneous pinning of the medial malleolus?

There is no CPT code for that exact technique. Report 27899 (unlisted procedure, leg or ankle) and attach the operative note, a procedure description, and a comparison to the closest established procedure to support payment.

03Can 27766 and 27792 (lateral malleolus ORIF) be billed together for a bimalleolar fracture?

AMA guidance steers coders toward the bimalleolar code 27814 when both malleoli are fixed. Reporting 27766 + 27792 separately for what is effectively a bimalleolar repair is a known audit trigger. Use 27814 and document both fixation sites in the operative note.

04What modifiers are required for laterality?

Append LT (left) or RT (right) to every 27766 claim. Many payers reject claims without laterality. If both ankles are fixed in one session — rare — use modifier 50 and confirm with the payer whether they require one line with 50 or two lines with LT/RT.

05Does the 90-day global include cast changes and hardware checks?

Yes. Routine follow-up visits, cast changes, wound checks, and stitch removal within 90 days of 27766 are bundled into the global. Bill unrelated conditions with modifier 24. Use modifier 78 for an unplanned return to the OR related to the original repair (e.g., wound dehiscence requiring I&D). Use modifier 79 for a completely unrelated surgical procedure during the global.

06Is modifier 22 ever appropriate for 27766?

Yes, when the work significantly exceeds the typical procedure — severe comminution, revision after prior failed fixation, or morbid obesity adding substantial operative time and complexity. Document the additional time, describe what made the case atypical, and expect payer audit scrutiny.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the surgical approach (open incision), specific fixation hardware used, fracture location confirmed as isolated medial malleolus, and laterality directly from dictation. It flags when intraoperative findings mention lateral or posterior malleolus involvement — prompting the coder to evaluate whether 27766 still applies or whether 27814/27822 is the correct code. This prevents the most common audit trigger: an operative note describing multi-malleolar work billed under an isolated medial malleolus code.

See how Mira captures CPT 27766 documentation