Manipulation of the ankle joint performed under general anesthesia, including application of traction or other fixation apparatus as needed.

Verified May 8, 2026 · 6 sources ↓

Medicare: $154.65
Total RVUs: 4.63
Global, days: 10
Region: Foot & ankle

Drawn from CMSAbosAacpm

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify that general anesthesia was used and document the clinical indication requiring anesthesia for the manipulation
Record pre- and post-manipulation range of motion findings to demonstrate medical necessity
Note any traction technique or fixation apparatus applied during the procedure
Confirm laterality (left, right, or bilateral) explicitly in the operative note
Document that the manipulation was performed as a standalone procedure, not incidental to an anatomically related surgical procedure on the same date

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 58 Staged or related 59 Distinct service 76 Repeat, same 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 27860 describes ankle joint manipulation carried out under general anesthesia — used when a conscious patient cannot tolerate or adequately relax for the maneuver. The procedure includes any traction or fixation apparatus applied during the same session. It carries a 10-day global period, meaning routine follow-up care through postoperative day 10 is bundled into the payment. Podiatry accounts for the majority of utilization per CMS Physician Fee Schedule 2026 data.

A critical NCCI rule governs this code: when ankle manipulation under anesthesia is performed during another procedure in an anatomically related area — to assess range of motion, reduce a fracture, or any other purpose — 27860 is not separately reportable. That bundling rule is explicit in both the Medicare and Medicaid NCCI Policy Manuals (2025 revision). Attempting to unbundle it will trigger an NCCI PTP edit denial.

Side laterality matters at billing. Append LT or RT as appropriate; if performed bilaterally, Medicare professional claims report modifier 50 on one line, while ASC facilities should use two claim lines with LT and RT respectively. Mismatched or missing laterality modifiers are a routine reason for claim rejection on ankle procedures.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	2.33
Practice expense RVU	1.95
Malpractice RVU	0.35
Total RVU	4.63
Medicare national rate	$154.65
Global period	10 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	$154.65
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 27860 get rejected.

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

NCCI PTP edit bundles 27860 into a same-session anatomically related ankle or leg procedure — most common denial scenario
Missing or incorrect laterality modifier (LT/RT) causes claim rejection before adjudication
Lack of documentation supporting medical necessity for general anesthesia rather than local or monitored anesthesia care
Only one fracture/dislocation repair code is payable per anatomic site; 27860 billed alongside a fracture repair code at the same site will be denied as mutually exclusive
Insufficient range-of-motion documentation makes auditors unable to verify that the procedure was performed and distinct from evaluation only

Frequently asked questions

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

01Can 27860 be billed alongside an ankle fracture repair on the same date?

No. The NCCI Policy Manual explicitly states that manipulation under anesthesia performed during another procedure in an anatomically related area is not separately reportable. Billing 27860 with a same-site fracture or dislocation repair code will generate a PTP edit denial.

02What modifiers are required for a bilateral ankle manipulation under anesthesia?

For Medicare professional claims, report modifier 50 on a single line. For ASC facility claims, submit two lines — one with LT and one with RT. Confirm individual payer rules, as some commercial plans follow different bilateral reporting conventions.

03Does the 10-day global period bundle post-op visits?

Yes. All routine follow-up care through postoperative day 10 is included in 27860's payment. A visit within the global for a reason unrelated to the manipulation requires modifier 24 on the E/M code.

04Is 27860 appropriate for subtalar joint examination under anesthesia?

This is a contested coding scenario. No CPT code specifically describes subtalar examination under anesthesia, and some coders have used 27860 as the closest analog. Document the specific joint examined by name; payer acceptance varies and the claim may require supporting documentation or appeal.

05What ICD-10 diagnoses most commonly support 27860?

Post-traumatic ankle stiffness, ankle joint contracture, and post-surgical adhesions of the ankle are the most common supporting diagnoses. The diagnosis must reflect a condition that requires manipulation under anesthesia — a routine office-visit stiffness complaint won't clear medical necessity review.

06Can 27860 be reported with an anesthesia code separately?

The procedure includes general anesthesia by its own descriptor. The surgeon cannot separately bill an anesthesia code. An independent anesthesiologist or CRNA involved in the case bills anesthesia under the appropriate ASA code separately from the surgeon's claim.

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 anesthesia type, laterality, pre- and post-manipulation range of motion, and any traction or fixation apparatus applied — the exact documentation elements auditors check first. This prevents the two most common denial triggers: missing laterality modifiers and unsupported medical necessity for general anesthesia.

See how Mira captures CPT 27860 documentation