CPT Code 27245: Intertrochanteric femoral fracture with IM implant

Key Takeaways

CPT code 27245 covers surgical treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture using an intramedullary implant, with or without interlocking screws and/or cerclage

Interlocking screws and cerclage wire are bundled within the 27245 descriptor and cannot be billed separately

The code carries a 90-day global period; modifiers -24, -25, and -79 apply when billing separately billable services during that window

Pabau’s claims management software supports accurate CPT 27245 submission through structured operative documentation and integrated billing workflows

CPT code 27245 describes a specific surgical procedure: treatment of an intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture using an intramedullary implant, with or without interlocking screws and/or cerclage. This reference covers the code’s official descriptor, procedure context, modifiers, ICD-10 crosswalk, 2026 Medicare reimbursement rates, RVU values, documentation requirements, and common billing errors to avoid.

CPT code 27245: Definition and clinical description

According to the American Medical Association (AMA), CPT code 27245 is maintained within the Musculoskeletal System section of the CPT manual, 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. Understanding the anatomical distinction between them 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 is critical for billing: both techniques are bundled into the code. Billing interlocking screw placement or cerclage wire as a separate line item on the same claim is incorrect and will draw NCCI edit scrutiny.

CPT 27245 vs CPT 27236: key differences

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

The key documentation test: if the operative report references an intramedullary nail inserted into the trochanteric or subtrochanteric region, CPT 27245 is correct. If the report describes femoral neck fixation or prosthetic head replacement, use CPT 27236. Misapplying either code based on implant type alone (without verifying 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. Primary modifier guidance applies to Medicare; commercial payers may have different requirements.

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

ICD-10 codes that support medical necessity for CPT 27245

CPT code 27245 requires a supporting ICD-10-CM diagnosis code that confirms the fracture type matches the code descriptor. The primary ICD-10 ranges are S72.1xx (trochanteric fractures) and S72.2xx (subtrochanteric fractures). Laterality is encoded in the 7th character.

Use 7th character “A” for the initial encounter (active treatment phase, including surgical intervention). Subsequent encounters use “D” and sequelae use “S.” Medicare may not accept all ICD-10-CM subtrochanteric codes across all MACs; verify against your local coverage article (LCA) if applicable. Payer policies on accepted diagnosis codes vary.

Medicare reimbursement and fee schedule for CPT 27245

CPT 27245 is a high-value orthopedic surgical procedure with Medicare reimbursement rates that vary by place of service and geographic locality. The CMS Physician Fee Schedule (MPFS) lookup tool is the authoritative source for current 2026 rates. The national payment amounts below are approximate figures based on published MPFS data; actual reimbursement will differ by Geographic Practice Cost Index (GPCI) locality.

Practices submitting CPT 27245 claims through a clearinghouse can validate electronic remittance advice against expected payment rates to catch underpayments early. Pabau integrates with electronic claims via Claim.MD, supporting real-time eligibility verification and ERA processing for orthopedic surgery claims.

Always verify rates against the CMS MPFS for the specific year and locality before quoting expected reimbursement. Geographic adjustments can raise or lower these figures by 15-30% depending on the practice’s location. Practices using a clearinghouse benefit from automated claim status tracking; read more about how a clearinghouse for orthopedic claims handles 27245 submissions across multiple payers.

RVU breakdown for CPT code 27245

Relative value units (RVUs) determine Medicare payment by multiplying the total RVU by the annual conversion factor and the GPCI for the practice’s locality. The FastRVU 2026 lookup tool provides current work, practice expense, and malpractice RVU values from official CMS data. The table below reflects published RVU components; verify against the CMS RVU file for 2026 before use in revenue calculations.

Practice managers calculating expected revenue per case should multiply the total facility RVU by the 2026 conversion factor and the locality’s GPCI. Use the PCC free 2026 RVU/RBRVS calculator to apply locality multipliers without needing the CMS data files directly. Note that these are physician payment figures only; facility fees (hospital or ASC) are reimbursed separately under a different payment system.

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 these is a common cause of denial or post-payment audit. Solid medical billing compliance workflows for orthopedic surgery start with structured documentation at the time of service.

• Fracture type and location: The operative report must explicitly identify 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 required by facility policy.
• Interlocking screws and/or cerclage: Record whether these were used. Because they are bundled, there is no separate line item, but their use must be documented for medical record integrity.
• Surgical approach: Open versus percutaneous approach should be documented, though 27245 covers both.
• Laterality: Right or left must appear in the operative report and be reflected in the ICD-10 7th character and modifier.
• Pre-operative imaging: X-ray or CT findings confirming fracture classification support medical necessity.

Submitting a superbill with all required procedure and diagnosis codes before the claim leaves the office reduces scrub-time and denial risk. The 837 claim file format is the standard electronic submission vehicle 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. This means routine post-operative care for the fracture repair is bundled into the surgical payment for 90 days following the procedure date.

• Included in global period: Post-op office visits, wound checks, routine fracture follow-ups, and removal of hardware that is considered 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 result in denial. The payer’s system automatically bundles payment for that visit into the surgical fee already paid.

Common billing errors and how to avoid them

Orthopedic surgery claims for CPT 27245 attract payer scrutiny because of their relatively high dollar value. These are the errors that most frequently trigger denial management in healthcare workflows for hip fracture cases.

• Using 27236 instead of 27245: Code selection must be based on fracture location in the operative report, not on implant type. If the implant is an IM nail but the fracture was in the femoral neck, 27236 is still correct.
• Billing cerclage or interlocking screws separately: These are bundled within the 27245 descriptor. Billing them with a separate line item triggers NCCI edit denials.
• Omitting laterality: Claims without a laterality modifier (-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” without device details creates audit vulnerability.
• Post-op visit billing without modifiers: Any E&M billed during the 90-day global period without an appropriate modifier will deny.

Tracking denial codes in medical billing for 27245 claims helps billing teams identify whether denials stem from code selection errors, documentation gaps, or modifier omissions, and fix the root cause rather than just resubmitting.

Related CPT codes in the hip and femur fracture family

CPT code 27245 sits within a family of hip and proximal femur fracture codes. Selecting the right code requires knowing which adjacent codes exist and how they differ. The AAPC Codify CPT lookup provides the full hierarchy with official descriptors for each.

Note the distinction between 27244 and 27245: both cover the trochanteric region, but 27244 uses a plate-and-screw construct while CPT 27245 specifies an intramedullary implant. The operative report’s implant description determines which code applies.

Streamline orthopedic billing with Pabau

Pabau helps orthopedic and surgical practices manage clinical documentation, invoicing, and billing code workflows in one place. Accurate records from the operative note through to claim submission, with built-in compliance support.

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How Pabau supports orthopedic billing and CPT code management

Accurate CPT 27245 billing depends on one thing more than any other: the operative report matching the code. When documentation and billing live in separate systems, discrepancies accumulate. Pabau’s claims management software connects clinical notes directly to invoicing, so the information coders need is already structured at the time of billing.

For orthopedic and surgical practices, Pabau’s workflow supports revenue cycle management from procedure documentation through claim submission. The platform integrates with Claim.MD for electronic claims across 4,000+ US payers, supporting the 837P format, real-time eligibility verification, and ERA/835 remittance processing. For practices billing high-complexity surgical codes like CPT code 27245, the audit trail from clinical note to claim helps defend medical necessity in the event of a payer review.

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

Conclusion

CPT code 27245 is a high-value, high-scrutiny orthopedic code where small documentation gaps translate directly into denials and audit exposure. The three most common failure points are code confusion with 27236, missing laterality modifiers, and incorrect post-global-period billing without the right modifier.

Pabau’s integrated clinical documentation and billing workflow keeps the operative detail coders need connected to the claim, reducing the gap between what was done and what gets submitted. To see how Pabau handles orthopedic billing workflows, explore our claims management features or book a demo with the team.

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.

Want to reduce post-payment audit risk? Medical billing compliance workflows outlines documentation and audit-trail practices for high-value surgical codes.

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