Closed treatment of a distal fibula fracture (lateral malleolus) without manipulation — no reduction performed, fracture managed with immobilization only.
Verified May 8, 2026 · 4 sources ↓
- Medicare
- $350.04
- Total RVUs
- 10.48
- Global, days
- 90
- Region
- Foot & ankle
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 4 cited references ↓
- Specify fracture location as distal fibula (lateral malleolus) with imaging correlation — avoid generic 'ankle fracture' language
- Document the clinical rationale for treating without manipulation — fracture alignment, displacement measurement, and stability assessment
- Record the type of immobilization applied (short leg cast, posterior splint, walking boot) and weight-bearing instructions given
- Note which provider is assuming global follow-up care versus handing off — this determines whether casting codes can be billed separately
- For bilateral fractures, document each side independently with separate clinical findings and laterality confirmed on imaging
- If billing modifier 22 for increased complexity, document specific factors that made the encounter significantly more work than typical (e.g., severe osteoporosis, patient comorbidities requiring extended counseling)
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 4 cited references ↓
CPT 27786 covers closed treatment of a distal fibular fracture without manipulation. The fracture is stable enough that no reduction is attempted; management consists of immobilization (cast, splint, or walking boot). The code sits within the fracture and dislocation procedures for the leg and ankle joint family, distinct from 27788 (with manipulation) and from bimalleolar codes like 27808.
The 90-day global period means all routine follow-up — including cast changes, wound checks, and radiograph reviews related to the fracture — is bundled from day 0 through day 90. Casting and strapping are explicitly bundled per NCCI; never bill 29581 or other splinting codes separately when 27786 is reported and you're assuming follow-up care. If a different physician applies the initial cast without assuming global care, they bill the casting code plus an E&M instead.
Bilateral distal fibula fractures are reported with modifier 50 or separate line entries with LT/RT. If the operative or clinical note covers both ankles, document each side's fracture pattern, stability assessment, and immobilization type independently. Payers vary on whether they accept modifier 50 versus separate lines for bilateral fracture care — confirm with each payer before submission.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 2.94 |
| Practice expense RVU | 7 |
| Malpractice RVU | 0.54 |
| Total RVU | 10.48 |
| Medicare national rate | $350.04 |
| 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 | $350.04 |
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 27786 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Casting or splinting code (e.g., 29581, 29515) billed same-day — NCCI bundles immobilization into 27786 when the treating provider assumes global care
- Laterality missing or inconsistent — claim submitted without LT/RT modifier while payer requires it, or modifier conflicts with imaging report
- E&M billed same-day without modifier 25 — if a separately identifiable evaluation precedes the fracture treatment decision, modifier 25 is required on the E&M
- Code selected doesn't match documented procedure — using 27786 when notes describe attempted reduction, which requires 27788 (with manipulation)
- Global period billing conflict — subsequent fracture-related visits billed without modifier 24, triggering automatic denial during the 90-day window
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 4 cited references ↓
01Can I bill a splint or cast application separately with 27786?
02What's the difference between 27786 and 27788?
03How do I bill bilateral distal fibula fractures?
04Can I bill an E&M on the same day as 27786?
05What happens if the fracture displaces during the 90-day global and requires manipulation?
06Is 27786 appropriate when a walking boot is used instead of a cast?
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 (distal fibula, lateral malleolus), laterality, imaging-confirmed alignment and displacement, the treating provider's decision not to manipulate, and the immobilization type applied — along with who is assuming global follow-up care. This prevents the two most common denials for 27786: a mismatch between the documented procedure and the billed code (manipulation vs. no manipulation), and inappropriate same-day casting code submission when the treating provider owns the 90-day global.
See how Mira captures CPT 27786 documentation