Closed treatment of a trimalleolar ankle fracture (medial, lateral, and posterior malleoli) performed without manipulation.

Verified May 8, 2026 · 6 sources ↓

Medicare: $382.11
Work RVU: 2.99
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCNIHMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Explicit identification of all three malleoli as fractured — medial, lateral, and posterior malleoli must each be named
Statement that no manipulation was performed to reduce the fracture
Clinical basis for fracture stability justifying closed treatment without manipulation
ICD-10-CM fracture code with correct 7th character for encounter type (initial, subsequent, sequela)
Mechanism of injury and relevant imaging findings supporting the trimalleolar diagnosis
Post-procedure plan including immobilization type, weight-bearing status, and follow-up schedule

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 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 XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

27816 covers closed management of a trimalleolar ankle fracture — all three malleoli involved (medial, lateral, and posterior) — where no manipulation is required. The fracture pattern is stable enough that the treating physician can manage it without repositioning the fragments. No surgical incision or internal fixation is included in this code; if open reduction or hardware placement is performed, a different code applies.

The 90-day global period governs this code. That window covers the day-before visit, the procedure itself, and all routine follow-up through day 90 — including cast changes, wound checks, and progress visits directly related to the fracture. Billing any related E/M within the global requires modifier 24. An unrelated procedure in the global period needs modifier 79; a staged or related return procedure needs modifier 78.

Differentiating 27816 from adjacent codes is critical. Bimalleolar fractures (two malleoli) use 27808 or 27810. Trimalleolar with manipulation uses 27818. Confirm in the operative or clinical note that all three malleoli are documented as fractured and that no manipulation was performed — both elements must be explicitly stated to support this code.

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 (2.99) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (11.44) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	2.99
Practice expense RVU	7.83
Malpractice RVU	0.62
Total RVU	11.44
Medicare national rate	$382.11
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	$382.11
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 27816 get rejected.

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

Documentation fails to name all three malleoli — note says 'ankle fracture' without specifying trimalleolar pattern
Claim billed as 27816 but note documents manipulation, which maps to 27818 instead
ICD-10-CM code missing or incorrect 7th character for encounter type, causing mismatch with CPT
Related E/M visit billed in the 90-day global period without modifier 24, triggering automatic denial
Bilateral modifier 50 applied without payer authorization — bilateral trimalleolar fractures are uncommon and flag for medical review

Frequently asked questions

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

01What separates 27816 from 27818?

27816 is closed treatment without manipulation. 27818 is closed treatment with manipulation. The operative or clinical note must explicitly state that no manipulation was performed to support 27816.

02Can I bill 27816 if internal fixation is also performed?

No. If the surgeon places hardware or makes an incision, you're in open treatment territory. Closed treatment codes cover non-surgical management only — no plates, screws, or open reduction.

03What is the global period for 27816 and what does it include?

27816 carries a 90-day global. That covers the day-before visit, the procedure, and all routine fracture-related follow-up through day 90, including cast changes and progress visits. Unrelated procedures in that window need modifier 79.

04How do I bill a related E/M visit during the 90-day global?

Append modifier 24 to the E/M if it addresses the trimalleolar fracture or a complication directly related to it. Without modifier 24, the claim will deny as bundled into the global.

05Which ICD-10-CM codes pair with 27816?

Trimalleolar fracture codes from the S82.8x- range are the primary match. The 7th character must reflect the correct encounter type — 'A' for initial encounter, 'D' for subsequent, 'S' for sequela. Submitting without the 7th character is a common denial trigger.

06Can 27816 be billed bilaterally with modifier 50?

Bilateral trimalleolar fractures are rare and will draw medical review. If you have a documented bilateral case, modifier 50 is technically applicable, but expect payer scrutiny and have imaging and clinical notes ready to support medical necessity.

07Is 27816 appropriate when the posterior malleolus fragment is very small?

Coding follows documentation, not fragment size. If the treating physician documents fracture of all three malleoli, 27816 (or 27818 with manipulation) applies. If only two malleoli are fractured regardless of fragment size, use the bimalleolar series (27808 or 27810).

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 from dictation — confirming all three malleoli are named, that no manipulation was performed, and that the treating physician documented the clinical rationale for closed management. This prevents the most common denial driver: a note that says 'trimalleolar fracture' without explicitly ruling out manipulation, which auditors and payers use to challenge 27816 and redirect to 27818.

See how Mira captures CPT 27816 documentation