CPT code 27514 – Open femoral shaft fracture surgery

Key Takeaways

CPT code 27514 describes open treatment of a distal femoral shaft fracture with internal fixation, distinct from supracondylar and proximal femur codes.

The correct ICD-10-CM pairing comes from the S72 code range; laterality (left vs. right) must be specified on every claim.

CPT 27514 carries a 90-day global surgery period under Medicare, bundling most postoperative follow-up visits.

Pabau’s claims management tools help orthopedic practices track prior authorisation requirements and submit clean 27514 claims through the Claim.MD clearinghouse.

CPT code 27514: Official descriptor and procedure overview

CPT code 27514 describes “open treatment of femoral shaft fracture, with or without external fixation, with insertion of intramedullary implant, with or without cerclage.” Published by the American Medical Association, the code belongs to the musculoskeletal surgery section of the CPT codebook, specifically the femoral shaft subsection.

The key anatomical distinction: 27514 covers the femoral shaft, the long mid-portion of the thigh bone. It does not cover the distal condylar region (CPT 27513) or the proximal femur and hip (CPT 27244, 27245). Getting the anatomy right before selecting the code is the single most important step in preventing a denial.

• Procedure type: Open treatment (surgical exposure of the fracture site)
• Fixation method: Intramedullary implant (nail), with or without cerclage wire
• External fixation: Included when used in the same session
• Code family: Femoral fracture codes CPT 27500 through CPT 27580
• Code section: Musculoskeletal system, Surgery

What CPT code 27514 covers and what it excludes

Understanding the scope of 27514 prevents both undercoding and upcoding. The code bundles the intramedullary nailing procedure in its entirety, including the same-session application of external fixation and cerclage wiring.

CPT 27514 vs. neighboring codes: Choosing the right code

The femoral fracture code family (CPT 27500 through 27580) trips up experienced coders because the descriptors differ only by anatomical site and treatment method. The comparison below isolates the key differentiators.

The 27514 vs. 27513 distinction: 27514 covers the femoral shaft. CPT 27513 covers the supracondylar region, the distal flare of the femur just above the condyles. When the fracture line crosses both zones, document the primary fracture site and select the code that matches where the principal fixation was performed.

Required ICD-10 diagnosis codes for CPT code 27514 claims

Every CPT 27514 claim needs a primary ICD-10-CM diagnosis from the S72 femur fracture range. Laterality is mandatory: Payers reject claims that use an unspecified-side code when the operative report clearly documents a left or right femur.

Use the 7th character “A” for initial encounter (the surgical date). If the patient has a complication encounter or non-union follow-up, switch to “D” (subsequent encounter) or “G” (subsequent encounter for fracture with delayed healing). Claims submitted with the wrong 7th character are rejected as a simple keying error but are frequently misclassified as a medical necessity denial.

Applicable modifiers for CPT code 27514

Modifier selection for 27514 depends on the operative scenario. Using no modifier when one is required, or appending the wrong modifier, is one of the top denial triggers for this code.

Medicare reimbursement rates and RVU values for CPT code 27514

Medicare reimbursement for CPT 27514 is calculated from the Medicare Physician Fee Schedule (MPFS) using relative value units (RVUs). Rates change annually and vary by geographic locality. The figures below reflect national averages; practices should verify current rates using the CMS Physician Fee Schedule Lookup Tool for their specific locality.

RVU values are multiplied by the annual Medicare conversion factor (CF) to derive the payment rate, then adjusted by the Geographic Practice Cost Index (GPCI) for your locality. Because 27514 is almost always performed in a hospital or ASC, the facility-rate RVUs apply. Use the FastRVU lookup tool to calculate the exact dollar amount for your locality and confirm the current-year values before billing.

Commercial payers typically reimburse at a percentage above or below Medicare rates, specified in the provider contract. Most commercial contracts for major orthopedic procedures pay 110-140% of Medicare, but this varies considerably by payer and market. Verify your contracted rate before quoting estimated patient responsibility.

Global surgery period and postoperative care for CPT 27514

CPT 27514 carries a 90-day global surgery period under the Medicare global surgery package, meaning most postoperative care provided within 90 days of the procedure date is bundled into the 27514 payment and cannot be billed separately.

• Bundled (cannot bill separately): Routine follow-up visits, suture/staple removal, wound checks, cast or brace adjustments, postoperative imaging interpretation when ordered as part of normal follow-up
• Separately billable with modifier 24: Unrelated E/M services during the global period (e.g., the patient presents with chest pain unrelated to the fracture)
• Separately billable with modifier 25: Significant, separately identifiable E/M service on the day of the procedure, prior to the decision to operate (pre-op evaluation beyond the typical preoperative assessment)
• Separately billable with modifier 79: Unrelated procedure performed during the global period
• Separately billable without a modifier: Staged or related procedures explicitly excluded from the global package per CMS guidance

Understanding medical billing fundamentals around global periods helps practices avoid inadvertent bundling errors that lead to overpayment recovery demands. The 90-day clock starts on the day of the procedure, and CMS requires that the postoperative period assignment for 27514 be verified against the current-year MPFS indicator before billing any same-period services.

Prior authorization requirements for CPT code 27514

Prior authorisation requirements for CPT 27514 vary significantly by payer and plan. No universal rule applies. Medicare fee-for-service does not require prior auth for 27514, but Medicare Advantage plans, Medicaid managed care plans, and commercial insurers frequently do.

• Medicare FFS: No prior authorisation required for 27514
• Medicare Advantage: Typically requires prior auth; request must include imaging (X-ray or CT), clinical documentation of fracture type and displacement, and the treating surgeon’s operative plan
• Commercial PPO/HMO: Most plans require prior auth for inpatient orthopedic surgery; submission window is typically 2-5 business days pre-procedure for elective cases, or retroactive review for emergency trauma
• Medicaid managed care: Requirements vary by state and plan; check the payer portal before scheduling

Maintaining strong medical billing compliance processes means building prior auth tracking into the scheduling workflow rather than chasing it on the morning of surgery. Document the auth number on every claim line. A missing or expired auth number is the fastest path to a denial on 27514.

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Common claim denial reasons for CPT 27514 and how to prevent them

Denials for CPT code 27514 cluster around four root causes: Wrong code selection, ICD-10 mismatch, missing prior auth, and documentation gaps. Each is preventable with the right pre-claim workflow.

• Wrong code selection: Billing 27514 when 27506 (open treatment without IM implant) or 27513 (supracondylar fracture) was performed. Fix: Audit the operative note for the exact fixation method and fracture site before code assignment.
• ICD-10 laterality mismatch: Submitting a right-laterality ICD-10 code when the operative note documents a left femur. Fix: Build a laterality cross-check into the coding workflow; never assign the ICD-10 before reading the operative note.
• Missing or expired prior auth: Procedure performed without valid authorisation on file. Fix: Assign auth tracking to a dedicated staff member and confirm the auth number before the case is posted.
• Incorrect 7th character on ICD-10: Submitting encounter qualifier “D” (subsequent) on the surgical date instead of “A” (initial). Fix: “A” is used for all visits actively treating a fracture, including the surgery itself.
• Modifier 22 without documentation: Appending increased complexity modifier without an operative note that quantifies the additional time and describes the complicating factors. Payers audit and reverse modifier 22 payments routinely. Fix: Document intraoperative complexity explicitly in the note.
• NCCI bundling errors: Billing a companion procedure alongside 27514 without modifier 59 when CMS edits bundle it. Fix: Run the code pair through the NCCI edit table before submission.

Effective denial management workflows for 27514 include a pre-submission checklist that flags the most common denial triggers for orthopedic surgical claims before they leave the practice. Refer to the full list of denial codes in medical billing to match payer remittance advice remark codes to the specific error type when a 27514 claim comes back.

Documentation requirements to support a CPT code 27514 claim

The operative report is the billing document for 27514. Payers that audit this code look for specific elements that confirm open treatment with intramedullary fixation was performed on the femoral shaft. A vague or incomplete note is the most common root cause of medical necessity denials after the fact.

• Fracture classification: Document AO/OTA classification (e.g., 32-B2 transverse shaft fracture) or at minimum fracture pattern (transverse, oblique, spiral, comminuted, segmental) and displacement status
• Laterality: State “right femur” or “left femur” explicitly in the procedure heading, body, and postoperative diagnosis
• Surgical technique: Confirm open reduction was performed; name the nail type and manufacturer if possible (e.g., retrograde femoral nail, antegrade nail)
• Cerclage wiring: If performed, describe the number and location of cerclage wires; this supports the “with or without cerclage” component of the descriptor
• External fixation: If a temporary ex-fix was applied and removed in the same session, document that explicitly
• Complexity factors (if billing modifier 22): Quantify additional time, name the specific complicating factors (morbid obesity, periprosthetic fracture, severe comminution, prior surgery on the same limb), and state how they increased the difficulty relative to a standard 27514 case
• Imaging correlation: Reference the pre-operative imaging (X-ray, CT) in the note; payers want to see that the imaging supported the need for open fixation

Submitting complete claims through electronic claims via Claim.MD, Pabau’s integrated US clearinghouse, adds a real-time validation layer that catches claim format errors and payer-specific edit failures before the claim reaches the carrier.

The clearinghouse connects to 4,000+ US payers and processes CMS-1500 and 837P claims, returning ERA/835 remittances so practices can reconcile payments against expected 27514 reimbursement without a manual matching process. For practices managing volume orthopedic billing, Pabau’s claims management software tracks each claim through the full revenue cycle from submission to payment posting.

Maintaining consistent clean claim requirements at the point of submission reduces the average denial rate on major surgical codes like 27514. The AAPC Codify and PGM Billing CPT search are useful free references for confirming code descriptors and checking for code pairs before filing.

Conclusion

Getting CPT code 27514 right comes down to three things: Correct code selection (IM nail on femoral shaft, not plate fixation and not a supracondylar fracture), complete operative documentation that explicitly names the technique and laterality, and a pre-submission workflow that catches ICD-10 and prior auth issues before they create a denial. These are solvable problems with the right process.

Pabau’s integrated clearinghouse connection and claims management software give orthopedic billing teams real-time claim validation and revenue cycle visibility, so denials on high-value surgical codes like 27514 are caught at submission rather than discovered weeks later on a remittance.

To see how Pabau handles surgical billing workflows end-to-end, book a demo.

Continue your research

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