Closed treatment of a proximal tibiofibular joint dislocation, without anesthesia.

Verified May 8, 2026 · 4 sources ↓

Medicare: $402.81
Total RVUs: 12.06
Global, days: 90
Region: Knee

Drawn from CMSFindacode

Documentation requirements

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

Source · Editorial brief grounded in 4 cited references ↓

Confirm and document the proximal tibiofibular joint as the specific site of dislocation — not the knee joint itself
Record pre-reduction and post-reduction neurovascular status of the lower extremity
Document the reduction technique used and any fluoroscopic or imaging confirmation of successful reduction
Note that no anesthesia was required or administered to support 27831 vs. 27832
Record mechanism of injury and any associated soft tissue or ligamentous findings
Include post-reduction immobilization plan and weight-bearing instructions in the note

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 52 Reduced services 57 Decision for surgery 58 Staged or related 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 4 cited references ↓

CPT 27831 covers closed (non-operative) treatment of a dislocation at the proximal tibiofibular joint — the articulation between the fibular head and the lateral tibial plateau just below the knee. The procedure involves manual reduction of the dislocated joint without surgical incision. Because no anesthesia is required for this version, it is distinct from 27832, which adds anesthesia. The injury is uncommon and often missed on initial evaluation; accurate anatomic documentation is essential to support medical necessity.

The code carries a 90-day global period. All routine follow-up care through day 90 — including post-reduction imaging reviews, dressing changes, and immobilization checks — is bundled. A separate E/M service on the same date as reduction requires modifier 25 to survive NCCI scrutiny. Any unrelated procedure performed during the global window needs modifier 79; a related unplanned return to the OR needs modifier 78.

Site of service matters here. The HOPD and ASC payment rates differ substantially — see the Site of Service comparison table on this page. Document the reduction technique, the pre- and post-reduction neurovascular exam, and any imaging used to confirm reduction. Payers vary on whether fluoroscopic guidance billed separately is reimbursable; check your MAC's policy.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	4.61
Practice expense RVU	6.45
Malpractice RVU	1
Total RVU	12.06
Medicare national rate	$402.81
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	$402.81
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 27831 get rejected.

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

Claim billed as 27832 (with anesthesia) when no anesthesia was administered, or vice versa — verify code selection against the anesthesia record
Same-day E/M billed without modifier 25, triggering NCCI bundle denial
Insufficient documentation distinguishing proximal tibiofibular dislocation from a knee dislocation or fibular fracture, failing medical necessity review
Post-reduction follow-up visits billed during the 90-day global period without modifier 24 (unrelated E/M) or 78/79 for additional procedures

Frequently asked questions

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

01What is the difference between 27831 and 27832?

27831 is closed treatment of a proximal tibiofibular dislocation without anesthesia. 27832 covers the same reduction but requires anesthesia. Select based on what was actually administered — anesthesia records must match.

02Can I bill a separate E/M on the same day as the reduction?

Yes, but only with modifier 25 on the E/M. Without it, NCCI bundles the visit into the procedure. The E/M must reflect a separately identifiable evaluation beyond the decision to reduce the joint.

03How long is the global period for 27831?

90 days. Routine post-reduction visits, dressing checks, and immobilization management are bundled through day 90. Unrelated visits need modifier 24; unrelated procedures need modifier 79.

04Can I bill for imaging guidance used during the reduction?

Fluoroscopic guidance billed separately is payer-variable. Medicare MAC policies differ on whether guidance is considered integral to the reduction. Check your local coverage policy before adding a fluoroscopy code.

05Is 27831 payable in an ASC setting?

Yes. ASC and HOPD payment rates apply and differ significantly — refer to the Site of Service comparison table on this page for current 2026 figures.

06What modifier applies if the patient returns to the OR for a related complication within the global period?

Use modifier 78 for an unplanned return to the OR for a procedure related to the original reduction during the 90-day global. Modifier 79 applies only to unrelated procedures performed during the global window.

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 specific joint reduced (proximal tibiofibular), confirmation that no anesthesia was used, pre- and post-reduction neurovascular findings, reduction technique, and post-reduction imaging outcome — all from your dictation. That detail prevents the most common audit flag on this code: a note that documents a generic 'knee area injury' without naming the proximal tibiofibular joint, which gives payers grounds to downcode or deny for insufficient medical necessity.

See how Mira captures CPT 27831 documentation