Closed treatment of a posterior malleolus fracture with manipulation to restore anatomic alignment, performed without surgical incision.

Verified May 8, 2026 · 5 sources ↓

Medicare: $442.23
Work RVU: 5.01
Global, days: 90
Region: Foot & ankle

Drawn from CMSBedrockbillingFindacode

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Confirm fracture involves the posterior malleolus specifically — not just a general ankle fracture description
Document that manipulation was performed and describe the technique used to achieve reduction
Pre- and post-manipulation imaging (X-ray) confirming fragment displacement and post-reduction alignment
Immobilization type and application detail (cast, splint, boot) applied after reduction
Neurovascular status of the extremity before and after manipulation
If other malleolar fractures are also treated, document each fracture site and treatment separately 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 25 Significant separate E/M 50 Bilateral procedure 52 Reduced services 58 Staged or related 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 27768 covers closed (non-incisional) reduction of a posterior malleolus fracture requiring manual manipulation to correct fragment displacement. The posterior malleolus — the back lip of the tibia at the ankle mortise — is a distinct fracture component that must be documented separately from fibular or medial malleolus injuries billed under other codes. Manipulation means the provider physically corrected the fracture alignment; if no manipulation was performed, a lower-level closed-treatment code applies.

The code carries a 90-day global period. All routine post-op visits, cast checks, and immobilization management are bundled from the day before surgery through day 90. Do not separately bill casting or strapping codes (e.g., 29581) for the same ankle on the same date — NCCI policy bundles them explicitly when any musculoskeletal procedure code from the 20100–28899 range is reported for the same anatomic area.

Side-specific modifiers LT and RT are expected on every claim. Bilateral posterior malleolus fractures are rare but would require modifier 50 or separate line items per payer rules. If additional malleolar fractures (medial, lateral) are treated at the same encounter, check current NCCI PTP edits before reporting companion codes — some combinations require modifier 59 or XS to override bundling when the anatomic site distinction is documentable.

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 (5.01) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (13.24) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.01
Practice expense RVU	7.16
Malpractice RVU	1.07
Total RVU	13.24
Medicare national rate	$442.23
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	$442.23
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI G2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 27768 get rejected.

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

Casting or strapping code billed same-day for the same ankle — bundled under NCCI policy and not separately payable
Missing side modifier (LT or RT) causing claim rejection or returned-to-provider status
Documentation describes only a general ankle fracture without specifying the posterior malleolus as the treated structure
No manipulation documented — if reduction was not performed, 27768 does not apply and a lower-level code is required
Post-op services billed within the 90-day global period without modifier 24 for unrelated E/M visits

Frequently asked questions

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

01Can I bill a casting code alongside 27768?

No. NCCI policy explicitly bundles casting and strapping codes when any musculoskeletal procedure from the 20100–28899 range is reported for the same anatomic area. Do not separately report 29581 or similar codes for the same ankle on the same date.

02What is the global period for 27768?

90 days. Routine follow-up visits, cast changes, and immobilization checks are all bundled from the day before the procedure through day 90. Bill unrelated E/M services with modifier 24 during the global.

03When is modifier 22 appropriate for this code?

Use modifier 22 when the manipulation required substantially more work than typical — for example, severely comminuted fragments, failed initial reduction requiring repeat attempts, or significant body habitus. You must document the specific factors that increased complexity; a generic note will not survive audit.

04How does 27768 differ from closed treatment codes for medial or lateral malleolus fractures?

27768 is specific to the posterior malleolus. Medial and lateral malleolus fractures have their own CPT codes. If multiple malleoli are treated at the same encounter, check current NCCI PTP edits — some combinations bundle and require modifier 59 or XS with documentation of distinct anatomic site treatment.

05Is a separate E/M billable on the same day as 27768 in a clinic setting?

Only if a separately identifiable evaluation and management service was performed beyond the decision to treat. Use modifier 25 on the E/M. The E/M must be documented as a distinct service — not just the fracture assessment that led directly to the manipulation.

06What modifier is needed if the patient returns to the OR during the global period for a related complication?

Modifier 78 — unplanned return to the operating or procedure room for a related procedure during the postoperative period. Do not use modifier 79, which is for unrelated procedures.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the fracture site (posterior malleolus), the manipulation technique, pre- and post-reduction alignment findings from imaging, and the immobilization method applied — everything needed to defend 27768 over a no-manipulation code and to satisfy MAC documentation requirements. Missing manipulation language is the leading reason these claims are down-coded on audit.

See how Mira captures CPT 27768 documentation