Open surgical fixation of a weight-bearing articular surface fracture of the distal tibia (pilon/tibial plafond), addressing the fibula only with internal fixation hardware.

Verified May 8, 2026 · 4 sources ↓

Medicare: $812.98
Total RVUs: 24.34
Global, days: 90
Region: Foot & ankle

Drawn from AbosAAPCCMS

Documentation requirements

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

Source · Editorial brief grounded in 4 cited references ↓

Specify that this is a pilon or tibial plafond fracture involving the weight-bearing articular surface of the distal tibia
Explicitly document that fixation was performed on the fibula only — not the tibia — and explain the clinical rationale
Record all hardware used: plate size, screw count, wire or pin configuration
Document fracture pattern, displacement, and any articular comminution to support complexity
If staged, document the surgical plan at the time of fibula fixation to support modifier 58 on the subsequent tibia procedure
Include intraoperative fluoroscopy use in the operative note to confirm it is not separately billed

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 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 4 cited references ↓

27826 covers open treatment of a pilon or tibial plafond fracture — specifically when the surgeon fixes the fibula only, using plates, screws, wires, or pins. The fibula is stabilized to restore the structural integrity of the ankle mortise even though the primary injury involves the distal tibia's articular surface. This is one of three codes in the pilon fracture family: 27826 (fibula only), 27827 (tibia only), and 27828 (both tibia and fibula). CMS data show 27828 is reported far more frequently, so use of 27826 should be supported by an operative note that clearly explains why only the fibula was addressed.

The 90-day global period covers all routine post-op care through day 90. If the plan is staged — fibula first, then tibia — append modifier 58 to the subsequent tibia fixation code (27827) to signal a planned staged procedure within the global. If a separate, unrelated procedure is performed during the global, use modifier 79.

Fluoroscopy used intraoperatively for fracture reduction guidance is bundled into 27826 per NCCI policy — do not separately report fluoroscopy codes. If external fixation is applied in addition to internal fibula fixation as a distinct service, a separate code (e.g., 20690) may be reportable, but verify NCCI edits before billing both.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.82
Practice expense RVU	11.43
Malpractice RVU	2.09
Total RVU	24.34
Medicare national rate	$812.98
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	$812.98
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,682.29

Common denial reasons

The recurring reasons claims for CPT 27826 get rejected.

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

Upcoded to 27828 when operative note only supports fibula fixation — payer downcodes to 27826
Missing documentation of why only the fibula was fixed when a distal tibia fracture is diagnosed, triggering a medical necessity query
Fluoroscopy billed separately (e.g., 77002) when it is bundled into the procedure under NCCI
Modifier 58 omitted on staged tibia fixation (27827) within the 27826 global period, causing a duplicate procedure denial
ICD-10 diagnosis code does not specify distal tibia or pilon fracture, creating a CPT-diagnosis mismatch

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 4 cited references ↓

01Why would a surgeon bill 27826 (fibula only) when the fracture is in the distal tibia?

Pilon fractures often involve significant soft tissue injury. Surgeons frequently stage the repair: fibula fixation first to restore length and alignment of the ankle mortise, then return to fix the tibia once swelling resolves. 27826 captures that initial fibula-only procedure.

02What modifier goes on the tibia fixation (27827) performed later in the same global period?

Modifier 58 — staged or related procedure by the same surgeon during the postoperative period. The operative note for the original 27826 should document the staged plan to support this modifier on the subsequent claim.

03Can fluoroscopy be billed separately with 27826?

No. Per NCCI 2026 policy, intraoperative fluoroscopic guidance is bundled into open fracture treatment codes. Billing a separate fluoroscopy code alongside 27826 will trigger a NCCI PTP edit denial.

04When is 27828 correct instead of 27826?

Use 27828 when the surgeon fixes both the fibula and tibia in the same operative session. 27826 applies only when the fibula is the sole bone receiving fixation. CMS data show 27828 is by far the most commonly reported of the three pilon codes.

05Can external fixation be billed separately if applied at the same session as 27826?

Possibly. If external fixation is a distinct service separate from the internal fibula fixation, a code such as 20690 may be separately reportable. Check current NCCI PTP edits for the code pair before billing both on the same date of service.

06What ICD-10 codes support 27826?

Look to the S82 category — fractures of the lower leg. The code should specify distal tibia (pilon or tibial plafond) involvement and laterality. A nonspecific lower leg fracture code without distal tibia or articular surface detail creates a CPT-diagnosis mismatch that payers flag.

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/pilon), the bones fixed (fibula only versus tibia versus both), fixation hardware used, surgical approach, intraoperative imaging, and whether the procedure is part of a staged plan. That specificity directly supports code selection between 27826, 27827, and 27828 — the most common audit trigger for this family — and provides the rationale needed when a payer questions why only the fibula was addressed.

See how Mira captures CPT 27826 documentation