Closed treatment of a proximal fibula or shaft fracture without manipulation, typically involving cast or splint immobilization.

Verified May 8, 2026 · 6 sources ↓

Medicare: $353.38
Work RVU: 2.76
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCFindacodeKzanow

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Imaging (X-ray) confirming fracture location — proximal fibula or shaft — and displacement status
Explicit statement that no manipulation was performed and fracture was treated without reduction
Type of immobilization applied (long leg cast, short leg cast, splint, or brace) with laterality documented
Neurovascular assessment of the affected extremity documented in the note
ICD-10 fracture code with laterality and displacement status to match treatment selected
Mechanism of injury and fracture pattern to support medical necessity for the immobilization approach chosen

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 ↓

CPT 27780 covers closed treatment of a proximal fibula or shaft fracture without manipulation — meaning the fracture fragments are not manually repositioned. Treatment consists of immobilization via a long leg cast, splint, or brace applied in the office or outpatient setting. No incision is made and no reduction maneuver is performed. If manipulation is required to achieve or improve alignment, bill 27781 instead.

The 90-day global period means all routine follow-up visits, cast changes, and wound checks are bundled through day 90. Unrelated E/M services in that window need modifier 24; a separately identifiable E/M on the day of fracture treatment needs modifier 25. If the decision for fracture care is made during an E/M that same day, append modifier 57 to the E/M code.

For Medicare patients, NCCI rules apply a single-cast rule: if multiple fractures are treated without manipulation and stabilized with one cast or splint, only one closed fracture treatment code is reportable. Non-Medicare payers may follow CPT rules and allow separate codes per fracture — verify by contract.

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 (2.76) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (10.58) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	2.76
Practice expense RVU	7.26
Malpractice RVU	0.56
Total RVU	10.58
Medicare national rate	$353.38
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	$353.38
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI A2) Ambulatory surgical center (freestanding)	$135.54

Common denial reasons

The recurring reasons claims for CPT 27780 get rejected.

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

Upcoding to 27781 (with manipulation) when documentation does not describe a reduction maneuver
Missing laterality modifier (LT or RT) causing claim rejection at payer edit level
Unbundling multiple closed fracture codes under a single cast for Medicare Part B patients violating NCCI single-cast rule
Billing a separate E/M on the same date without modifier 25, triggering automatic bundling into the fracture care code
ICD-10 code mismatch — displacement status or laterality on the diagnosis code does not align with the treatment reported

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What's the difference between 27780 and 27781?

27780 is closed treatment without manipulation — you immobilize the fracture as-is. 27781 is used when you manually reposition the fragments before immobilization. The distinction must be explicit in the note; a vague 'fracture reduced and casted' will be read as manipulation by auditors.

02Do I need a modifier for a bilateral fibula fracture?

Bilateral fibula fractures are rare, but if both are treated, append modifier 50 for bilateral or use LT and RT on separate line items depending on payer preference. Verify with the payer — some commercial plans require separate lines while Medicare accepts modifier 50.

03Can I bill an E/M on the same day as 27780?

Yes, but only if the E/M is separately identifiable beyond the fracture evaluation. Append modifier 25 to the E/M. If the E/M visit resulted in the decision to treat the fracture, append modifier 57 to the E/M code instead.

04What happens if a second cast application is needed during the 90-day global?

Routine cast changes are bundled in the global period and are not separately billable. If a new cast is required due to an unrelated condition or a complication that constitutes a distinct clinical service, modifier 24 on a separate E/M may apply — document the distinct reason clearly.

05A patient has both a fibula shaft fracture and a distal radius fracture treated at the same visit with a single cast. Can I bill both fracture codes?

For Medicare Part B, NCCI rules allow only one closed fracture treatment code when multiple fractures are stabilized with a single cast without manipulation. For non-Medicare payers following CPT rules, separate codes per fracture are generally reportable. Check your contract before billing both codes to commercial payers.

06If the fracture later requires ORIF during the global period, which modifier applies?

Append modifier 58 to the open reduction code — it signals a staged or more extensive procedure during the post-operative period of 27780. Do not use modifier 78 unless the return to the OR is for an unplanned complication directly related to the initial fracture treatment.

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 location (proximal fibula vs. shaft), explicit confirmation that no manipulation was performed, the type and laterality of immobilization applied, and the neurovascular status of the extremity. This prevents the most common audit flag for 27780: operative or clinical notes that fail to distinguish non-manipulative treatment from 27781, or that omit laterality — both of which trigger downcoding or outright denial.

See how Mira captures CPT 27780 documentation