Open surgical repair of a bimalleolar ankle fracture involving any two of the three malleoli (lateral, medial, or posterior), with internal fixation when performed.

Verified May 8, 2026 · 6 sources ↓

Medicare: $714.45
Work RVU: 10.35
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCPayerpriceMdclarity

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 (lateral, medial, or posterior) — 'bimalleolar fracture' alone is insufficient without anatomic specificity
Confirm the surgical approach is open (direct visualization of fracture site), not closed or percutaneous
Specify internal fixation hardware used (plates, screws, etc.) if performed, including type and placement
Document the laterality of the operative ankle (left or right) to support LT/RT modifier assignment
Include pre-op imaging (X-ray or CT) confirming bimalleolar fracture pattern and displacement requiring open treatment
Operative note must distinguish 27814 from isolated medial malleolus (27766) or trimalleolar (27822/27823) cases if posterior malleolus is also addressed

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27814 covers open treatment of a bimalleolar ankle fracture — meaning two of the three malleoli are fractured (lateral and medial, lateral and posterior, or medial and posterior). Internal fixation with plates, screws, or other hardware is included in the code when performed; you don't add a separate fixation code. This is a high-complexity surgical procedure with a 90-day global period under CMS.

The code sits at the top of the bimalleolar ankle fracture series. Use 27808 for closed treatment without manipulation, 27810 for closed treatment with manipulation, and 27814 when the surgeon opens the fracture site for direct reduction and fixation. Surgeons sometimes document a 'distal fibula' or 'lateral malleolus' fracture rather than calling it bimalleolar — coders must map the anatomy in the operative note to confirm two malleoli are involved before applying 27814.

NCCI policy is explicit: initial casting, splinting, or strapping applied at the time of the procedure is bundled into 27814. Don't bill 29581 or any other strapping code alongside it, even if the post-op dressing simultaneously addresses edema or another condition. Separate fracture codes for a co-existing closed fracture without manipulation that is splinted by the same cast are also not separately reportable.

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 (10.35) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (21.39) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	10.35
Practice expense RVU	9
Malpractice RVU	2.04
Total RVU	21.39
Medicare national rate	$714.45
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	$714.45
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,843.35

Common denial reasons

The recurring reasons claims for CPT 27814 get rejected.

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

Operative note documents only one malleolus, triggering down-code to 27766 or 27786 on audit
Strapping or splinting code (e.g., 29581) billed same-day — bundled per NCCI policy; denied without appeal basis
Laterality modifier (LT or RT) missing, causing claim suspension or payer rejection
27814 billed same-day as 27810 (closed reduction in ER) without modifier 58 to establish staged procedure relationship
Posterior malleolus fixation billed separately when all three malleoli are treated — should be coded to 27822 or 27823 for trimalleolar fractures, not 27814 plus an add-on

Frequently asked questions

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

01Can I bill 27814 if the surgeon only fixed the lateral malleolus but the medial side was also fractured?

Only if the operative note confirms open treatment of the bimalleolar fracture pattern as a whole. If the medial malleolus required no fixation and no open exposure, the claim may not support 27814. Some payers accept 27814 for bimalleolar equivalent fractures where medial-side instability is addressed without formal fixation — document the decision-making explicitly.

02Is casting or splinting separately billable after 27814?

No. Per NCCI Chapter 4, fracture treatment codes include the initial cast, splint, or strapping. Billing 29581 or any strapping code alongside 27814 will be denied. This applies even if the post-op dressing also treats edema or another condition.

03What code applies if all three malleoli are fractured?

A trimalleolar fracture goes to 27822 (without fixation of posterior lip) or 27823 (with fixation of posterior lip), not 27814. Using 27814 for a trimalleolar case underbills and misrepresents the procedure.

04A patient had closed reduction in the ER the same day as definitive ORIF. How do I handle both?

Bill 27814 for the ORIF with modifier 58 to indicate a staged or related procedure in the same global period. Do not bill 27810 (closed reduction) and 27814 on the same date without modifier 58 — payers will deny one as duplicate or bundled.

05When is modifier 22 appropriate for 27814?

Use modifier 22 when operative complexity significantly exceeds typical — for example, severe comminution requiring prolonged reconstruction, morbid obesity substantially increasing operative time, or re-operative fixation through prior scar. Attach a cover letter quantifying extra time and effort; payers require documentation support to approve the upward adjustment.

06Does 27814 carry a global period, and what does that include?

Yes — 90-day global. That covers the surgery itself, the day-before pre-op visit, and all routine post-op care through day 90. Unrelated visits during the global need modifier 79; related complications returning to the OR use modifier 78.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the fracture pattern (which two malleoli, displacement, and open vs. percutaneous approach), fixation hardware type and placement, and operative laterality directly from surgeon dictation. This prevents the most common audit trigger for 27814 — operative notes that identify only one malleolus or fail to confirm open exposure — which drives down-coding to a lower-value single-malleolus code.

See how Mira captures CPT 27814 documentation