Closed treatment of a posterior malleolus fracture without manipulation — no incision, no surgical reduction.

Verified May 8, 2026 · 5 sources ↓

Medicare: $321.65
Work RVU: 2.57
Global, days: 90
Region: Foot & ankle

Drawn from CMSNIHAAPCFindacode

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Imaging confirming posterior malleolus fracture with fracture location and fragment size noted
Explicit statement that no manipulation was performed and clinical rationale for non-operative management
Immobilization type applied (cast, splint, or boot) with laterality documented
Neurovascular status of the extremity before and after immobilization
ICD-10-CM fracture code with laterality and initial vs. subsequent encounter designator (7th character)

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 5 cited references ↓

27767 covers closed treatment of a posterior malleolus fracture when no manipulation is performed. The posterior malleolus is the back edge of the tibia at the ankle joint. When the fragment is acceptably aligned and stable, the treating provider manages it non-operatively — typically with immobilization via cast, splint, or boot — without attempting closed reduction. No incision is made and no reduction maneuver is documented.

27767 carries a 90-day global period. That covers the day of treatment, the day-before visit (if applicable), and all routine fracture follow-up through day 90. Unrelated E/M visits during the global window require modifier 24. A separate E/M on the same day as the procedure requires modifier 25, supported by a distinct medical decision-making note.

The posterior malleolus fracture often occurs alongside medial or lateral malleolus fractures — the classic bimalleolar or trimalleolar pattern. If you're treating a trimalleolar fracture closed, each component has its own code; report them with modifier 51 on the secondary code(s). When the injury progresses to require open reduction within the global period, that's a staged related procedure — use modifier 58.

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 (2.57) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (9.63) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	2.57
Practice expense RVU	6.58
Malpractice RVU	0.48
Total RVU	9.63
Medicare national rate	$321.65
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	$321.65
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI P2) Ambulatory surgical center (freestanding)	$135.54

Common denial reasons

The recurring reasons claims for CPT 27767 get rejected.

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

Missing manipulation status — payers deny when notes don't explicitly state whether manipulation was or was not performed
Incorrect 7th character on the ICD-10-CM diagnosis code (e.g., using 'D' for subsequent encounter on initial treatment visit)
Bundling denial when billed same-day as a related E/M without modifier 25 and a distinct decision-making note
Laterality not documented — claim lacks LT or RT modifier or operative note omits side
Global period violation — routine follow-up visit billed separately within the 90-day window without modifier 24

Frequently asked questions

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

01What is the difference between 27767 and 27768?

27767 is closed treatment of a posterior malleolus fracture without manipulation. 27768 is the same fracture treated with manipulation — meaning the provider performed a closed reduction to realign the fragment. Use 27767 only when no reduction maneuver is attempted or needed.

02Can I bill 27767 with an E/M on the same day?

Yes, but only if the E/M represents a separate, distinct medical decision — document it separately and append modifier 25 to the E/M code. A note that solely documents the fracture and the immobilization will not support a separate E/M.

03How do I bill a trimalleolar fracture treated closed?

Report each malleolus component with its own code. Append modifier 51 to the secondary and tertiary procedure codes. For a trimalleolar pattern, 27767 covers the posterior malleolus component when no manipulation is performed on that fragment.

04What happens if the posterior malleolus fracture later requires ORIF within the global period?

Use modifier 58 to indicate a staged, related procedure by the same surgeon during the global period. This distinguishes it from a return for a complication (modifier 78) and allows separate reimbursement for the open procedure.

05Which ICD-10-CM code pairs with 27767?

Use S82.12- for posterior malleolus fracture with the appropriate laterality character (1 = right, 2 = left, 9 = unspecified) and 7th character A for initial encounter active treatment. Confirm displacement status in the note to select the correct sub-code.

06Does 27767 require the physician to apply the cast or splint personally?

The global package for fracture care includes casting and splinting. If a separate provider applies the cast on the same day and that service is billed independently, a bundling conflict arises. Document who performed the immobilization and bill accordingly under the global.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the posterior malleolus fracture location, fragment size from imaging, explicit documentation that no manipulation was performed, clinical rationale for closed non-operative management, immobilization type applied, laterality, and neurovascular exam findings. This prevents the most common audit flag: operative or procedure notes that fail to state manipulation status, which triggers payer requests for records or outright denial.

See how Mira captures CPT 27767 documentation