Closed treatment of a bimalleolar ankle fracture — involving any two of the three malleoli — without reduction or manipulation of the fracture fragments.

Verified May 8, 2026 · 6 sources ↓

Medicare: $382.44
Work RVU: 2.95
Global, days: 90
Region: Foot & ankle

Drawn from AAPCMedicalbillgurusCMS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify which two malleoli are fractured (e.g., lateral and medial, lateral and posterior, medial and posterior) — do not document just 'ankle fracture'
Explicitly state that no manipulation was performed; note that the fracture was treated with casting or splinting only
Include imaging findings (X-ray or CT) confirming fracture pattern and acceptable alignment without reduction
Document laterality (left or right ankle) to support LT/RT modifier use
Record the type and application of immobilization device (short leg cast, posterior splint, etc.)
If fluoroscopy was used to confirm alignment, note it in the operative or procedure note — but do not bill it separately unless payer policy explicitly permits

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 51 Multiple procedures 52 Reduced services 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 XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27808 covers closed fracture care for bimalleolar ankle fractures where no manipulation is performed. Bimalleolar means two of the three malleoli are involved: most commonly the lateral and medial malleoli, but also lateral-posterior or medial-posterior combinations. Because the fracture is treated without surgical exposure and without manual reduction, casting or splinting is the definitive intervention. The fracture site is never opened; no internal fixation is placed under this code.

The 90-day global period covers the casting/splinting visit, all routine follow-up, cast changes, and removal through day 90. Anything unrelated to the fracture care billed within that window needs modifier 24 (E/M) or modifier 79 (unrelated procedure). If manipulation is later required, that becomes a separate encounter and escalates to 27810. If the fracture ultimately requires open fixation, that shifts to 27814 — use modifier 58 if it's a planned staged procedure within the global.

Common place of service is the emergency room (POS 23) or office (POS 11). External fixator application billed same-day (20690 or 20692) is separately reportable — verify NCCI edits before appending modifier 59. Fluoroscopy used intraoperatively to confirm alignment is typically bundled into the fracture care code and not separately billable.

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 (2.95) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (11.45) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	2.95
Practice expense RVU	7.92
Malpractice RVU	0.58
Total RVU	11.45
Medicare national rate	$382.44
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	$382.44
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 27808 get rejected.

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

Upcoding to 27810 or 27814 without documented manipulation or surgical exposure — payers audit whether 'closed without manipulation' language appears in the note
Missing laterality in documentation when LT or RT modifier is appended on the claim
Separate billing of cast application (29405–29450) that is bundled into the 27808 global package
Fracture care billed with a same-day E/M that lacks modifier 25 and a distinct, separately documented reason for the visit
External fixator code (20690/20692) billed without confirming NCCI edit status and appending modifier 59/XS as required

Frequently asked questions

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

01When does a bimalleolar fracture case shift from 27808 to 27810?

The moment the provider performs any manual reduction of the fracture fragments, the encounter moves to 27810. If you started with 27808 in the ER and manipulation is done at a follow-up visit, bill 27810 for that subsequent encounter. The documentation must explicitly state that reduction was performed.

02Can I bill an E/M on the same day as 27808?

Yes, but it requires modifier 25 on the E/M and a separately documented medical decision distinct from the fracture itself. In ER settings, the typical choice is either the E/M with a -57 modifier (if definitive surgical decision is being made for a major procedure) or the fracture care code — not both. For 27808 in an office or ED setting, append modifier 25 to any separately justified E/M.

03Is cast application bundled into 27808?

Yes. The casting or splinting used to immobilize the fracture is included in the 27808 global — it's the treatment, not a separately billable service. Do not bill 29405–29450 on the same date as 27808 for the initial immobilization.

04Can I bill an external fixator separately with 27808?

Potentially yes — 20690 (uniplane) or 20692 (multiplane) may be separately reportable when an ex-fix is applied alongside closed fracture care. Check NCCI edits first; if there is a bundling conflict, append modifier 59 or XS with clear documentation of the distinct nature of the fixator application.

05Does a posterior malleolus fracture paired with a lateral malleolus fracture qualify for 27808?

Yes. The code covers lateral-posterior and medial-posterior combinations in addition to the more common lateral-medial pattern. Document which specific two malleoli are fractured — 'bimalleolar' alone is not sufficient.

06What modifier applies if the same ankle requires repeat closed treatment by the same physician?

Use modifier 76 for a repeat application of the same procedure by the same physician on a different date. If the repeat procedure is by a different physician, use modifier 77.

07How does the 90-day global period affect billing for this code?

The 90-day global includes all routine post-fracture visits, cast changes, and stitch or staple removal through day 90. Unrelated procedures or E/M visits during that window require modifier 79 or 24, respectively, with documentation clearly establishing the separate medical issue.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the specific malleoli involved, the absence of manipulation, immobilization method applied, and laterality directly from physician dictation. This prevents the most common 27808 audit flag — operative notes that say 'ankle fracture, closed treatment' without specifying the two-malleolus pattern or confirming no reduction was attempted.

See how Mira captures CPT 27808 documentation