Closed treatment of a proximal fibula or shaft fracture requiring manual manipulation to restore bone alignment, without surgical incision.

Verified May 8, 2026 · 5 sources ↓

Medicare: $490.66
Work RVU: 4.48
Global, days: 90
Region: Foot & ankle

Drawn from CMSGenhealthAAPCMdclarityFindacode

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Imaging (X-ray or CT) confirming fracture location — proximal fibula or shaft — taken before and after manipulation
Explicit documentation that manipulation was performed to achieve or improve alignment; notes that omit this support 27780 (no manipulation), not 27781
Description of post-reduction immobilization method (splint, cast, brace) and position of immobilization
Anesthesia or sedation type used, if applicable (local, regional, conscious sedation), including consent
Neurovascular status of the extremity documented pre- and post-procedure
Fracture classification or displacement description supporting medical necessity for manipulation

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 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another 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 27781 covers closed (non-surgical) treatment of a proximal fibula or shaft fracture where the provider manually manipulates bone fragments back into acceptable alignment. The distinction from 27780 is the manipulation — if no manipulation is performed, use 27780. Post-reduction immobilization (splint, cast, or brace) is bundled into this code and not separately billable.

The 90-day global period starts on the date of treatment. All routine follow-up visits, cast changes, and fracture checks through day 90 are included. If a complication arises requiring a separate, unrelated service in that window, append modifier 24 or 25 to the E/M. A return to the OR for a complication related to the original fracture care uses modifier 78; an unrelated procedure in the global uses modifier 79.

Site of service matters. The procedure is reportable in the ED, outpatient clinic, or ASC. Facility payments differ substantially between HOPD and ASC settings — see the Site of Service comparison table on this page. Most payers follow Medicare's global policy, but some commercial contracts have different global period structures; verify before unbundling post-op visits.

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 (4.48) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (14.69) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	4.48
Practice expense RVU	9.28
Malpractice RVU	0.93
Total RVU	14.69
Medicare national rate	$490.66
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	$490.66
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 27781 get rejected.

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

Manipulation not documented — operative or procedure note only states fracture was 'immobilized,' triggering downcoding to 27780
Post-op E/M visits billed without modifier 24 or 25 during the 90-day global period
Laterality modifier (LT or RT) missing — required by most payers for unilateral lower-extremity fracture codes
ICD-10 diagnosis code does not specify proximal fibula or shaft location, causing a code-to-diagnosis mismatch denial
Separate billing for casting or strapping supplies when bundled into the global fracture care payment

Frequently asked questions

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

01What is the difference between 27780 and 27781?

27780 is closed treatment without manipulation; 27781 requires that the provider manually manipulated the fracture fragments to improve alignment. If your note doesn't document manipulation, you're billing 27780, not 27781.

02Is casting or splinting separately billable with 27781?

No. Immobilization — cast, splint, or brace applied at the time of fracture treatment — is bundled into 27781. Separate casting codes are not payable on the same date for the same fracture.

03Can I bill an E/M on the same day as 27781?

Only if the E/M is a significant, separately identifiable service. Append modifier 25 to the E/M and document a decision-making or history element distinct from the fracture treatment itself.

04How do I handle a return to the OR during the 90-day global for a related complication?

Append modifier 78 to the return procedure code. That signals an unplanned return for a complication related to the original fracture care. Modifier 79 is for a procedure that is unrelated to the original treatment — do not mix these up.

05Is laterality required when billing 27781?

Most payers require modifier LT or RT for unilateral lower-extremity fracture procedures. Missing laterality is a common, easily avoided denial. Append LT or RT on every claim.

06When would modifier 22 apply to 27781?

If the manipulation was substantially more difficult than typical — for example, severe swelling, obesity, or an unstable fracture pattern requiring multiple reduction attempts — modifier 22 is appropriate. Document the specific circumstances adding time and complexity; payers will want that justification in the record before paying the increase.

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 fracture site (proximal fibula vs. shaft), the manipulation technique performed, post-reduction alignment confirmed on imaging, immobilization type and position, and neurovascular status pre- and post-procedure. This prevents the most common audit flag for 27781 — procedure notes that document casting but omit explicit language confirming that manipulation was performed, which auditors use to downcode the claim to 27780.

See how Mira captures CPT 27781 documentation