Closed treatment of a weight-bearing articular fracture of the distal tibia (pilon or tibial plafond fracture), without manipulation, with or without anesthesia.

Verified May 8, 2026 · 6 sources ↓

Medicare: $356.72
Total RVUs: 10.68
Global, days: 90
Region: Foot & ankle

Drawn from CMSNIHAAPCFindacode

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Imaging (X-ray or CT) confirming fracture of the weight-bearing articular surface of the distal tibia (pilon/tibial plafond)
Explicit statement that no open surgical approach and no manipulation of fracture fragments was performed
Neurovascular status of the extremity documented pre- and post-treatment
Fracture classification or description of articular comminution pattern to support medical necessity
Immobilization or casting method applied and patient weight-bearing status instructions
Clinical rationale for closed non-manipulative management (e.g., non-displaced, patient comorbidities)

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 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27824 covers closed, non-manipulative treatment of a pilon or tibial plafond fracture — the weight-bearing articular surface of the distal tibia. No incision is made and no reduction of fracture fragments is performed. The procedure may be carried out with or without anesthesia. This is the least invasive option in the pilon fracture coding family; when manipulation is added, 27825 applies, and open treatment escalates to 27826–27828 depending on fibular involvement.

The 90-day global period means all routine post-op fracture management — cast changes, follow-up imaging reads reported under the global, and standard office visits — is bundled from the date of service through day 90. New problems or unrelated visits in that window require modifier 24. A decision-for-surgery visit on the same day requires modifier 57 if it was an E/M at the major-surgery threshold.

Pilon fractures frequently involve associated soft-tissue injury, compartment syndrome risk, and staged treatment plans. If a separately identifiable procedure is performed at the same encounter — for example, fasciotomy or fibula fixation — use modifier 59 or the appropriate XS modifier to distinguish distinct services, provided NCCI edits permit unbundling. Document the fracture pattern, articular involvement, neurovascular status, and treatment rationale clearly; vague operative notes are the primary audit trigger for this code family.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	3.23
Practice expense RVU	6.8
Malpractice RVU	0.65
Total RVU	10.68
Medicare national rate	$356.72
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	$356.72
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 27824 get rejected.

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

Code selected does not match treatment rendered — manipulation performed but 27824 (no manipulation) billed instead of 27825
Insufficient documentation of articular involvement; generic 'distal tibia fracture' language without specifying pilon or tibial plafond
Routine post-op follow-up visits billed separately during the 90-day global period without modifier 24
Imaging not documented in the record or not linked to the treating encounter
Bilateral modifier applied without documentation of bilateral pilon fractures — extremely rare and will trigger review

Frequently asked questions

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

01What distinguishes 27824 from 27825?

27824 is closed treatment without manipulation — the fracture is immobilized as-is. 27825 is closed treatment with manipulation, meaning the surgeon reduces the fracture fragments without opening the skin. If you performed any reduction, 27825 is the correct code.

02Can I bill for the cast or splint application separately?

No. Cast application is bundled into 27824 under global surgery rules. Separate cast/strapping codes (e.g., 29405, 29425) are not reportable by the same physician on the same date for the same extremity when the global procedure includes immobilization.

03Is fluoroscopy separately billable with 27824?

Fluoroscopy used to confirm fracture position during closed treatment is generally considered integral to the procedure and not separately reportable per NCCI policy. If a distinct diagnostic imaging service is performed at a separate session, that is a different question — consult current NCCI PTP edits.

04What modifier do I use for a related complication requiring return to the OR within the 90-day global?

Use modifier 78 for an unplanned return to the operating room for a complication related to the original pilon fracture treatment. Modifier 79 applies only if the return procedure is completely unrelated to the original fracture.

05Does 27824 require a specific ICD-10 code pairing?

Yes. The ICD-10 should reflect a pilon or tibial plafond fracture with articular involvement — typically from the S82.87x family (pilon fracture of tibia). A generic distal tibia fracture code without articular specification may trigger a mismatch edit. Use laterality suffixes (A for initial encounter, D for subsequent, S for sequela) correctly.

06Can 27824 and a fibula fracture code be billed together on the same day?

Potentially, if the fibula fracture is treated as a distinct service. Check current NCCI PTP edits for the specific code pair. If unbundling is permitted, modifier 59 or XS documents the distinct anatomic site. Document both fractures separately in the operative or clinical note.

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 tibia, articular surface), confirms the closed non-manipulative approach in the operative note, records anesthesia use, and documents neurovascular exam findings and immobilization method. This prevents the most common audit flag: operative notes that describe a pilon fracture without explicitly stating no manipulation was performed, which reviewers use to challenge whether 27824 or 27825 was the correct code.

See how Mira captures CPT 27824 documentation