Open surgical treatment of a proximal fibula or shaft fracture, with internal fixation applied as needed.

Verified May 8, 2026 · 6 sources ↓

Medicare: $673.03
Work RVU: 9.43
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCNIHAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Fracture location specified as proximal fibula or fibular shaft (not distal/ankle)
Operative note documents open approach with direct fracture visualization
Fixation method named explicitly (plate, screws, wires, pins, or combination)
If concurrent tibial fracture treated same session, separate documentation of independent fibular fracture diagnosis and rationale for separate fixation
Pre-op imaging (X-ray or CT) confirming fracture pattern and location
Laterality documented (left or right fibula) in operative note and on claim

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 58 Staged or related 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

27784 covers open treatment of a fracture at the proximal fibula or fibular shaft. The surgeon makes an incision to access the fracture site, reduces the fragments under direct visualization, and secures fixation — typically with plates and screws, wires, or pins — when the fracture pattern requires it. This is a distinct code from closed treatment (27781) and from distal fibula/ankle fracture codes in the 27786–27829 range.

27784 carries a 90-day global period. That window covers the surgery itself, the day-before pre-op visit, and all routine follow-up through day 90 — including wound checks, suture removal, and cast or splint management. Anything unrelated to the fibula fracture billed during that window needs modifier 24 (E/M) or 79 (unrelated procedure). A staged or planned second procedure billed in the global uses modifier 58; an unplanned return to the OR for a related complication uses modifier 78.

Bundling is the primary coding hazard here. When the same operative session includes tibial shaft fixation (e.g., 27758 or 27759), payers — including UnitedHealthcare — frequently bundle 27784 as inclusive, arguing the fibular fixation is part of the tibial fracture work. Append modifier 51 and support with an operative note that documents the fibular fracture as a separate injury requiring independent fixation. NCCI edits govern the column relationships; review current edits before billing same-session tibial and fibular codes.

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 (9.43) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (20.15) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	9.43
Practice expense RVU	8.86
Malpractice RVU	1.86
Total RVU	20.15
Medicare national rate	$673.03
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	$673.03
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 27784 get rejected.

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

Bundled with 27758 or 27759 when tibial and fibular fractures treated in same session — payer treats fibular fixation as inclusive
Laterality missing from claim; LT/RT modifier absent causing NCCI or payer edit failure
Code selected for distal fibula or ankle fracture that maps to 27786 or 27792 instead
Global period violation — post-op E/M billed without modifier 24 within 90-day window
Medical necessity not established when pre-op imaging or clinical notes do not support need for open versus closed treatment

Frequently asked questions

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

01How does 27784 differ from 27781?

27781 is closed treatment of a proximal fibula or shaft fracture — no incision. 27784 is the open equivalent, requiring direct surgical exposure and reduction. If you opened it, 27781 is wrong.

02Can I bill 27784 and 27758 together when both the tibia and fibula are fractured and fixed in the same session?

Technically yes with modifier 51, but expect resistance. UHC and other payers frequently bundle 27784 into 27758, treating fibular fixation as inclusive. You need an operative note that clearly documents the fibular fracture as a separate lesion requiring independent fixation, not just incidental stabilization during tibial nailing.

03Which modifier covers an unplanned return to the OR for wound dehiscence after 27784?

Modifier 78 — unplanned return to the OR for a complication related to the original procedure. Do not use modifier 79 (that's for an unrelated procedure in the global) or modifier 58 (that's for a planned staged procedure).

04Does 27784 apply to distal fibula fractures at the ankle?

No. Distal fibula fractures at the ankle level are coded from the 27786–27829 range depending on the fracture type and fixation method. 27784 is specifically for the proximal fibula and shaft.

05Is laterality required on the claim?

Yes. Append LT or RT. Missing laterality is a common technical denial trigger and can also flag the claim for NCCI edit review when bilateral modifiers are expected.

06What justifies modifier 22 on 27784?

Significantly increased operative work — for example, a severely comminuted fracture requiring extended OR time, complex multi-fragment reconstruction, or a revision after failed prior fixation. Document increased time, complexity, and any unusual anatomical challenges in the operative note. Without that documentation, modifier 22 will be denied or ignored.

Sources & references

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

Mira Scribe

Mira's AI scribe captures fracture location (proximal fibula vs. shaft vs. distal), the surgical approach, fixation hardware used, and whether a concurrent tibial fracture was addressed in the same session. That detail prevents the two most common denial paths: miscoding to an ankle fracture code and same-session bundling with 27758 or 27759 when independent fibular fixation is documented.

See how Mira captures CPT 27784 documentation