Closed treatment of a pilon or tibial plafond fracture involving the weight-bearing articular surface of the distal tibia, performed using skeletal traction, manual manipulation, or both — with or without anesthesia.

Verified May 8, 2026 · 6 sources ↓

Medicare: $604.22
Total RVUs: 18.09
Global, days: 90
Region: Foot & ankle

Drawn from AAPCFindacodeJposnaCMS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify fracture type by name: pilon, tibial plafond, or Salter II of distal tibia as applicable
Document that manipulation and/or skeletal traction was performed — not just immobilization — to distinguish from 27824
Record anesthesia type used (local, regional, or general) or document none was required
Pre- and post-reduction imaging results confirming fracture alignment
Note any external fixation device applied, including whether uniplane or multiplane, to support separate billing of 20690 or 20692
If staged return to OR is planned, document intent at initial operative note to support modifier 58 on the subsequent procedure

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 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 73 Discontinued pre-anesthesia 74 Discontinued post-anesthesia 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 6 cited references ↓

CPT 27825 covers nonsurgical reduction of unstable distal tibia fractures involving the weight-bearing articular surface — the pilon or tibial plafond. What separates 27825 from 27824 is the method: this code requires skeletal traction (pins or wires through bone) and/or manual manipulation to restore alignment. After reduction, the limb is immobilized and alignment is confirmed with imaging. No fracture site incision is made; if the fracture is directly visualized and fixed with hardware, you're in the 27826–27828 range instead.

External fixation applied to distract and realign the fracture can be reported separately — 20690 for uniplane or 20692 for multiplane fixation systems — in addition to 27825. If the surgeon uses an external fixator as a temporizing measure and later returns for open internal fixation, that second procedure bills under the appropriate open code (27827 or 27828) with modifier 58 to signal a planned staged return.

The 90-day global period covers all routine post-op visits, cast changes, and imaging reads through day 90. Unrelated E/M services in that window need modifier 24. If a significant separate E/M is documented on the day of the procedure, append modifier 25. Percutaneous techniques that don't involve direct fracture visualization — such as Tillaux fracture reduction with percutaneous screw placement — fall outside 27825 and are better reported with the unlisted code 27899 with a comparison narrative.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.52
Practice expense RVU	10.22
Malpractice RVU	1.35
Total RVU	18.09
Medicare national rate	$604.22
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	$604.22
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 27825 get rejected.

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

Upcoding flag when 27825 is billed without documented manipulation or traction — payers downcode to 27824
Bundling of separately applied external fixation (20690/20692) without documentation clearly supporting a distinct and separately billable fixation procedure
Post-reduction imaging professional component billed separately — NCCI policy bars separate payment for the professional read of comparative post-procedure imaging
Modifier 58 missing on staged open fixation (27827/27828) performed during the 90-day global period of 27825
Unlisted code 27899 not submitted with comparison narrative when percutaneous technique makes 27825 an incorrect fit

Frequently asked questions

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

01What's the difference between 27824 and 27825?

Method of reduction. 27824 is for closed treatment without manipulation — essentially immobilization only. 27825 requires skeletal traction and/or manual manipulation to realign the fracture. If the operative note doesn't document traction or manipulation, payers will downcode to 27824.

02Can I bill 20690 or 20692 on the same day as 27825?

Yes. When an external fixator is applied as part of the reduction — either as a temporizing measure or to maintain alignment — you report the fixation code separately. Use 20690 for uniplane fixation and 20692 for multiplane (e.g., Ilizarov-type). Document the fixation device and configuration in the operative note.

03The surgeon applied an external fixator at the first visit and returned two weeks later for open internal fixation. How do I code the second procedure?

Report 27827 or 27828 (depending on whether the tibia, fibula, or both are fixed) with modifier 58. The staged or related procedure modifier is required here because the return to OR was planned at the time of the initial procedure. Without modifier 58, the claim will hit the 90-day global period of 27825 and be denied.

04Is 27825 correct for a percutaneous reduction of a Tillaux fracture with screw fixation?

No. Percutaneous techniques that don't directly visualize the fracture don't meet the definition of closed or open treatment. The correct code is 27899 (unlisted), submitted with a comparison to 27825 or 27827 and a narrative explaining the distinction. Without that explanation, expect processing delays or denial.

05Can I separately bill for the post-reduction X-ray read?

The professional component of a post-reduction imaging study is not separately payable under NCCI policy — it's considered part of confirming the procedure. The technical component may be reported separately if your practice bills globally. Don't append modifier 26 to the post-reduction film expecting separate reimbursement.

06Does a Salter II fracture of the distal tibia bill under 27825?

Yes, when manipulation or traction is used. The 27824–27825 pair applies to Salter II fractures of the distal tibia. Use 27825 if the orthopedist reduces the fracture with manipulation or skeletal traction; use 27824 if the fracture is managed without manipulation.

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 characterization (pilon vs. tibial plafond), the specific reduction method (skeletal traction, manipulation, or both), anesthesia type, external fixation details including plane configuration, and post-reduction imaging findings — all from the operative dictation. That documentation prevents downcoding to 27824 and supports separate billing of 20690 or 20692 without triggering a bundling denial.

See how Mira captures CPT 27825 documentation