Closed reduction with manipulation of a bimalleolar ankle fracture — any two-malleolus combination (lateral/medial, lateral/posterior, or medial/posterior) — without surgical opening of the fracture site.

Verified May 8, 2026 · 7 sources ↓

Medicare: $562.14
Work RVU: 5.19
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCFindacodeGenhealthAAOS

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Identify which two malleoli are fractured — lateral/medial, lateral/posterior, or medial/posterior combination
Specify that treatment was closed (fracture site not surgically exposed or visualized)
Document that manipulation was performed — if no manipulation, 27808 applies instead
Record pre- and post-reduction imaging confirming fracture alignment
Note anesthesia or sedation type used during manipulation
Document immobilization method applied (cast, splint, type and location)
Include mechanism of injury and neurovascular status of the extremity

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 51 Multiple procedures 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 7 cited references ↓

CPT 27810 covers closed treatment of a bimalleolar ankle fracture requiring manipulation. The fracture site is never surgically exposed; instead, the physician manually reduces the displaced fragments using traction and controlled movement, then verifies alignment with intraoperative imaging before immobilizing the ankle in a cast or splint. All three two-malleolus combinations fall under this code: lateral and medial, lateral and posterior, or medial and posterior malleoli.

The 90-day global period covers the day-before visit, the procedure itself, and all routine follow-up through day 90 — including cast changes, splint adjustments, and standard wound care. Unrelated E/M services during that window require modifier 24. A separate E/M on the same day as the procedure requires modifier 25 if a significant, separately identifiable service was provided before the decision to treat.

Site of service matters here. HOPD and ASC payments differ substantially (see the Site of Service comparison table). Emergency department is the most common place of service for this code given the acute injury pattern, followed by inpatient hospital settings. LT or RT is expected by most payers; missing laterality is a leading claim rejection trigger for ankle fracture 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 (5.19) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (16.83) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.19
Practice expense RVU	10.47
Malpractice RVU	1.17
Total RVU	16.83
Medicare national rate	$562.14
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	$562.14
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 27810 get rejected.

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

Missing laterality — LT or RT modifier absent, rejected by most commercial payers
Billed as open treatment when documentation only supports closed technique
27808 vs. 27810 mismatch — 27808 is without manipulation; using 27810 without documentation of manipulation triggers medical necessity denial
Trimalleolar fracture present but coded as bimalleolar — use 27816 or 27818 if all three malleoli are involved
Routine post-op services billed separately within the 90-day global without modifier 24 or 79
ICD-10 fracture code does not specify closed fracture type, causing CPT-diagnosis mismatch

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What is the difference between 27808 and 27810?

27808 is closed treatment without manipulation — used when the fracture is adequately aligned and only immobilization is needed. 27810 requires that manipulation was actually performed to reduce a displaced fracture. If your note doesn't document traction or manual reduction, 27808 is the correct code and 27810 will face medical necessity scrutiny.

02When does a bimalleolar fracture become a trimalleolar fracture for coding purposes?

When the posterior malleolus is also fractured and treated, you're in trimalleolar territory — report 27816 (closed, without manipulation) or 27818 (closed, with manipulation) instead of 27810. Document all three malleoli explicitly in the operative note; missing the posterior malleolus finding is a common undercoding error.

03Does 27810 require a laterality modifier?

Yes. Append LT or RT on every claim. Most commercial payers and Medicare contractors require laterality on unilateral ankle procedure codes. Claims without it are routinely rejected or suspended for manual review.

04Can I bill an E/M visit on the same day as 27810?

Only if a significant, separately identifiable evaluation and management service was performed before the decision to treat the fracture — for example, a visit that addressed a different problem or included a full workup that preceded the treatment decision. Append modifier 25 to the E/M. Routine fracture assessment immediately followed by reduction does not support a separate E/M.

05What global period applies to 27810, and what does it include?

90-day global. It includes the day-before preoperative visit, the procedure day, and all routine post-op care through day 90 — cast changes, splint adjustments, and standard follow-up visits. Bill separate services in that window only for unrelated conditions (modifier 24 on E/M, modifier 79 on procedures) or for planned staged procedures (modifier 58).

06Is modifier 22 ever appropriate for 27810?

Yes, when the manipulation is significantly more complex than typical — for example, extreme obesity requiring extended anesthesia time, or a severely comminuted fracture pattern requiring prolonged traction and repeated reduction attempts. You must document the additional time, effort, and complexity in the operative note, and most payers require a cover letter explaining the increased work.

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 specific malleoli involved, confirms the fracture site was not surgically exposed, flags that manual manipulation was performed and verified with post-reduction imaging, and records the immobilization method applied — all in the operative note. That documentation chain prevents the most common 27808-vs-27810 audit challenge and supports laterality modifiers at claim submission.

See how Mira captures CPT 27810 documentation