CPT code 27245: Intertrochanteric femoral fracture with IM implant

CPT code 27245 covers treatment of an intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture with an intramedullary implant. Interlocking screws and cerclage wire sit inside that descriptor, so neither is billable on a separate line.

The code carries 33.48 total facility RVUs and a 90-day global period. At the 2026 Medicare conversion factor that works out to roughly $1,118 in national physician payment, before any locality adjustment.

Code selection turns on the fracture location documented in the operative report, not on the implant the surgeon reached for. Femoral neck fixation stays with CPT 27236 even when an intramedullary nail was used.

Key takeaways

CPT code 27245 covers intertrochanteric, peritrochanteric, and subtrochanteric femoral fracture repair with an intramedullary implant.

Interlocking screws and cerclage wire are bundled into the descriptor, so billing either separately triggers an NCCI edit.

The code totals 33.48 facility RVUs, which pays about $1,118 nationally at the 2026 conversion factor.

A 90-day global period applies, and modifiers -24, -78, and -79 unlock separately billable services inside it.

Fracture location in the operative report decides between 27245 and 27236, never the implant type on its own.

CPT code 27245: Definition and clinical description

The American Medical Association (AMA) maintains CPT code 27245 in the Musculoskeletal System section of the CPT manual. It sits under the Pelvis and Hip subsection. The official descriptor reads: Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with intramedullary implant, with or without interlocking screws and/or cerclage.

Three fracture locations fall under this code. Telling them apart anatomically is the first step to applying it correctly.

The implant in 27245 is an intramedullary (IM) nail or rod inserted into the femoral canal. The descriptor’s “with or without interlocking screws and/or cerclage” language matters for billing, because both techniques are bundled into the code. Billing interlocking screw placement or cerclage wire as a separate line item on the same claim will draw NCCI edit scrutiny.

CPT 27245 vs CPT 27236: key differences

Confusing CPT 27245 with CPT 27236 is the most common upcoding or downcoding error in hip fracture billing. The boundary between the two codes is clear once you separate the femoral neck from the trochanteric region.

Here is the documentation test. If the operative report describes an intramedullary nail inserted into the trochanteric or subtrochanteric region, CPT 27245 is correct. If it describes femoral neck fixation or prosthetic head replacement, use CPT 27236. Picking either code from the implant alone, without checking the fracture location in the report, is a documentation integrity failure.

Modifiers for CPT code 27245

Modifier selection for CPT 27245 depends on clinical circumstances, laterality, and whether services fall inside or outside the 90-day global period. The guidance below applies to Medicare. Commercial payers may set different requirements.

The assistant-at-surgery split catches practices out. A physician assisting bills modifier 80, 81, or 82 and is paid 16% of the surgical fee. A PA or NP bills -AS instead, and Medicare pays 85% of that amount, which lands at roughly 13.6% of the surgeon’s fee.

Omitting laterality modifiers is among the top denial triggers for orthopedic surgical claims. Most Medicare Administrative Contractors (MACs) require -LT or -RT on unilateral procedures. Check your MAC’s local coverage documentation before billing.

ICD-10 codes that support medical necessity for CPT 27245

CPT code 27245 needs a supporting ICD-10-CM diagnosis code that confirms the fracture type matches the descriptor. The primary ranges are S72.1xx for trochanteric fractures and S72.2xx for subtrochanteric fractures. Laterality sits in the 6th character, and the 7th character records the encounter.

Use 7th character “A” for the initial encounter, which covers the active treatment phase and the surgery itself. Subsequent encounters take “D” and sequelae take “S.” Some MACs do not accept every subtrochanteric code, so check your local coverage article where one applies.

Medicare reimbursement and fee schedule for CPT 27245

CPT 27245 is a high-value orthopedic procedure, and its Medicare payment varies by place of service and geographic locality. The CMS Physician Fee Schedule (MPFS) lookup tool is the authoritative source for 2026 rates. The national amounts below come from the code’s 2026 RVUs and conversion factor, so actual payment will differ by Geographic Practice Cost Index (GPCI) locality.

Verify rates against the CMS MPFS for the specific year and locality before quoting expected reimbursement. Geographic adjustments can move these figures by 15% to 30% depending on where the practice operates. The hospital or ASC then bills its own facility fee on top, under a separate payment system.

RVU breakdown for CPT code 27245

Relative value units (RVUs) set Medicare payment. Multiply the total RVU by the annual conversion factor and by the GPCI for the practice’s locality. The three components below come from the CMS CY2026 RVU file, and work alone accounts for over half the total.

The CMS CY2026 final rule sets two conversion factors. It is $33.4009 for clinicians who are not qualifying APM participants, and $33.5675 for those who are. Multiplying 33.48 total facility RVUs by each figure gives $1,118.26 and $1,123.84 respectively, before GPCI. The visualization below traces that build-up.

Use the PCC free 2026 RVU/RBRVS calculator to apply locality multipliers without pulling the CMS data files yourself. These are physician payment figures only. Hospital and ASC facility fees are reimbursed separately.

Billing guidelines and documentation requirements for CPT code 27245

Claim approval for CPT 27245 depends on an operative report that contains specific elements. Missing any one of them is a common cause of denial or post-payment audit. Solid medical billing compliance for orthopedic surgery starts with structured documentation at the time of service.

• Fracture type and location: The operative report must name the fracture as intertrochanteric, peritrochanteric, or subtrochanteric. “Hip fracture” alone is insufficient.
• Implant identification: Document the specific intramedullary nail used, including manufacturer, device name, and lot number where facility policy requires it.
• Interlocking screws and/or cerclage: Record whether these were used. They are bundled, so there is no separate line item, but their use belongs in the record.
• Surgical approach: Open versus percutaneous approach should be documented, though 27245 covers both.
• Laterality: Right or left must appear in the operative report, and match both the ICD-10 7th character and the modifier.
• Pre-operative imaging: X-ray or CT findings confirming the fracture classification support medical necessity.

Building a superbill with every required procedure and diagnosis code before the claim leaves the office cuts scrub time and denial risk. The 837 claim file is the standard electronic submission format for these hospital outpatient and ASC claims.

Global period and post-operative billing

CPT 27245 carries a 90-day global period under the CMS MPFS. Routine post-operative care for the fracture repair is bundled into the surgical payment for 90 days after the procedure date.

• Included in global period: Post-op office visits, wound checks, routine fracture follow-ups, and removal of hardware counted as part of the primary repair
• Separately billable with modifier -24: E&M visits during the global period for conditions unrelated to the hip fracture
• Separately billable with modifier -79: A new unrelated surgical procedure performed during the 90-day window
• Separately billable with modifier -78: Return to the operating room for a complication directly related to the original procedure

Billing a post-op visit without one of these modifiers during the global period will deny. The payer’s system bundles payment for that visit into the surgical fee it already paid.

Common billing errors and how to avoid them

Orthopedic claims for CPT 27245 attract payer scrutiny because of their dollar value. These five errors trigger most denials on hip fracture cases.

• Using 27236 instead of 27245: Code selection follows the fracture location in the operative report, not the implant type. If the implant is an IM nail but the fracture sat in the femoral neck, 27236 is still correct.
• Billing cerclage or interlocking screws separately: Both are bundled within the 27245 descriptor. Billing them on a separate line triggers NCCI edit denials.
• Omitting laterality: Claims without -LT or -RT frequently pend or deny under Medicare and many commercial contracts. Laterality must match the ICD-10 7th character.
• Incomplete implant documentation: Payers auditing high-value orthopedic claims look for device identification in the operative report. A vague reference to “nail fixation” creates audit exposure.
• Post-op visit billing without modifiers: Any E&M billed during the 90-day global period without an appropriate modifier will deny.

Tracking denial reason codes across 27245 claims shows whether the problem is code selection, documentation, or a missing modifier. Fixing the root cause beats resubmitting the same claim twice.

Related CPT codes in the hip and femur fracture family

CPT code 27245 sits within a family of hip and proximal femur fracture codes. Picking the right one means knowing which adjacent codes exist and how they differ. The AAPC Codify CPT lookup carries the full hierarchy with official descriptors.

Both 27244 and 27245 cover the same three fracture zones. The construct is what separates them: 27244 is a plate-and-screw implant, and 27245 is an intramedullary nail. Read the whole family as a grid and the selection rule falls out of two documented facts.

How Pabau supports orthopedic billing and CPT code management

Accurate CPT 27245 billing rests on the operative report matching the code. When documentation and billing live in separate systems, a coder has to reconstruct the case. That means digging the fracture location and the implant out of whatever the note happened to say. Pabau is practice management software. Its claims management software connects clinical notes directly to invoicing, so the detail coders need is already structured when the claim goes out.

For orthopedic and surgical practices, Pabau supports revenue cycle management from procedure documentation through claim submission. It handles electronic claims across thousands of US payers, including the 837P format, real-time eligibility verification, and ERA remittance processing. On a high-complexity code like 27245, the audit trail from clinical note to claim helps defend medical necessity when a payer reviews the case.

Pabau serves orthopedic and sports medicine practices alongside medical spas, aesthetic practices, and multi-specialty groups. Every subscription includes the full billing and reporting functionality, with no feature gating by plan tier.

Keep the operative note and the claim in one record

Pabau connects clinical documentation to invoicing. The fracture location, implant detail, and laterality a 27245 claim needs are captured once and carried through to submission. That gives orthopedic practices fewer scrubber holds and a cleaner audit trail.

Book a demo

Conclusion

A CPT 27245 claim is decided in the operative report, long before it reaches a payer. If the note names the fracture location, the implant, and the side, the code and its modifiers follow from what is written. If it says “hip fracture, nail fixation,” a coder is guessing and an auditor will say so.

So the fix sits upstream of billing. Build fracture location, implant identification, and laterality into the operative template itself, and the scrubber has less to catch. That same discipline holds at the 90-day mark, where a post-op service needs -24, -78, or -79 to survive.

The trade-off worth remembering is that 27245 pays well and gets audited accordingly. Book a demo to see how an orthopedic claim moves from operative note to submission inside Pabau.

Continue your research

Need to understand how medical claims move through payers? How a medical claims clearinghouse works explains the role of clearinghouses in electronic claim submission and ERA processing.

Looking for a clean claim checklist before submission? Clean claim submission requirements covers the elements every orthopedic claim needs before it reaches the payer.

Denials piling up on high-value surgical codes? Denial management in healthcare sets out how to work a denial queue by reason code instead of resubmitting blind.

Want to know what the payer actually receives? The 837 claim file explained walks through the electronic format that carries your 27245 line items and modifiers.

Frequently asked questions