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CPT code 27767: Ankle fracture care, posterior malleolus, no manipulation2026 Medicare rate & RVUs in Puerto Rico

Report this service for nonoperative care of a posterior malleolus fracture when the provider treats the fracture without manipulating it.

CMS RVU26DEffective Oct 1, 2026One payment locality152 Medicare services in 2024

In Puerto Rico, Medicare pays $323.83 for 27767 in the office and $302.55 when it’s performed in a hospital or facility.

$323.83Office (non-facility)
$302.55Hospital or facility
+0.7%vs the national office rate ($321.65)

Check a contract rate as a % of Medicare · 27767 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 27767 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 27767 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 27767 covers

This code represents nonoperative care of a fracture at the posterior part of the distal tibia, where it forms the ankle joint. An orthopedic surgeon or other qualified practitioner may provide this care in an office, emergency department, or hospital when the treatment plan is closed management rather than operative fixation. The key distinction is that the provider does not manipulate the fracture to achieve or restore alignment.

The record should identify the posterior malleolus fracture, document the closed treatment plan, and support that no manipulation was performed. Code 27768 is the corresponding choice when manipulation is performed; open fixation is represented by a different code. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in one session, the highest-valued is paid in full and other procedures are subject to the standard 50% reduction. For bilateral reporting with modifier 50, CMS pays 150%. Assistant-at-surgery payment is restricted; co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Puerto Rico compares for 27767

Across 109 of 109 payment localities, the office rate for 27767 runs from $282.89 in Arkansas to $420.80 in San Benito County, CA. Puerto Rico pays $323.83. The RVUs are the same everywhere; the geographic indexes change the dollars.

27767 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$323.83
  2. Los Angeles, CA · California$360.00+$36.17
  3. Washington, DC area · District of Columbia$367.22+$43.39
  4. Miami, FL · Florida$355.18+$31.35
  5. Chicago, IL · Illinois$344.11+$20.28
  6. Manhattan, NY · New York$372.14+$48.31
  7. Alaska · Alaska$371.66+$47.83

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

27767 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$287.22$268.81
ArkansasArkansas$282.89$264.81
ArizonaArizona$312.53$292.14
Bakersfield, CACalifornia$338.11$315.05
Chico, CACalifornia$336.77$313.71
El Centro, CACalifornia$336.85$313.79
Fresno, CACalifornia$336.77$313.71
Hanford, CACalifornia$336.77$313.71

27767 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$282.89

$378.78

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
27767 office rate range by state
State / territoryOffice rate rangeLocalities
AK$371.661
AL$287.221
AR$282.891
AZ$312.531
CA$336.77–$420.8029
CO$333.241
CT$343.661
DC$367.221
DE$317.821
FL$320.04–$355.183
GA$300.99–$328.652
GU$345.011
HI$345.011
IA$293.301
ID$295.621
IL$311.56–$344.114
IN$297.371
KS$292.601
KY$295.891
LA$295.70–$310.862
MA$331.42–$366.042
MD$323.83–$367.223
ME$298.01–$313.762
MI$304.60–$324.962
MN$316.741
MO$290.90–$311.133
MS$286.921
MT$321.621
NC$301.141
ND$312.131
NE$294.761
NH$328.661
NJ$346.86–$363.312
NM$306.631
NV$319.191
NY$305.90–$382.425
OH$302.661
OK$294.561
OR$316.01–$343.322
PA$302.75–$335.302
PR$323.831
RI$328.801
SC$302.541
SD$311.011
TN$294.231
TX$300.73–$332.748
UT$306.831
VA$313.20–$367.222
VI$323.831
VT$311.531
WA$330.58–$372.902
WI$301.331
WV$299.771
WY$317.481

See 27767 in every payment locality

How the 27767 rate is calculated

Each of 27767’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 27767

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.57

2.57 RVUs× 1.000 GPCI

Practice expense6.58

6.58 RVUs× 1.000 GPCI

Malpractice0.48

0.48 RVUs× 1.000 GPCI

Adjusted RVUs

9.6300

Conversion factor

$33.4009

Medicare rate

$321.65

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

3,044

Code
27767
Physician work
2.57
Practice expense
6.58
Malpractice
0.48

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 27767 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work2.57× 1.0002.5700
Practice expense6.58× 1.0116.6524
Malpractice0.48× 0.9850.4728
Total RVUs9.6952
Conversion factor× 33.4009

Office rate, Puerto Rico$323.83

Office: (2.57 × 1 + 6.58 × 1.011 + 0.48 × 0.985) × $33.4009 = $323.83

Facility: (2.57 × 1 + 5.95 × 1.011 + 0.48 × 0.985) × $33.4009 = $302.55

Open 27767 in the RVU calculator

Payment rules and modifiers for 27767

27767 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 27767

Ankle fracture care, posterior malleolus, no manipulation

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.69/0.21Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 27767

Ankle fracture care, posterior malleolus, no manipulation

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

27767 without 50 · national office

$321.65

Ankle fracture care, posterior malleolus, no manipulation

27767-50 · Bilateral: 150%

$482.48

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

Codes related to 27767

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 27767
CodeHow it relatesOffice range, Puerto Rico
Same family
27768Ankle fracture treatment, posterior malleolus, with manipulationClosed treatment of a posterior malleolus fracture when manipulation is performed.No office rate
Used instead
27769Ankle fracture repair, open posterior malleolusOperative treatment with open fixation for a posterior malleolus fracture.No office rate
27808Ankle fracture care, bimalleolar, without manipulationClosed treatment without manipulation for a bimalleolar ankle fracture pattern.$385.06

How 27767 has changed in Puerto Rico

27767 · Office / nonfacility

$323.83

Effective 2026-10-01

The base rate is $24.51 higher than on 2025-10-01, moving from $299.32 to $323.83 (8.2%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $299.32changed to$323.83

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.64 changed to 2.57
    • Practice expense RVU 6.08 changed to 6.58
    • Malpractice RVU 0.50 changed to 0.48
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $303.02changed to$299.32

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 5.95 changed to 6.08
    • Malpractice RVU 0.48 changed to 0.50

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $298.07changed to$303.02

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $305.29changed to$298.07

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 5.84 changed to 5.95
    • Malpractice RVU 0.49 changed to 0.48
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $303.97changed to$305.29

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $305.51changed to$303.97

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 5.65 changed to 5.84
    • Malpractice RVU 0.50 changed to 0.49
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $303.49changed to$305.51

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 5.54 changed to 5.65
    • Malpractice RVU 0.48 changed to 0.50

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $298.65changed to$303.49

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 5.12 changed to 5.54
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $292.29changed to$298.65

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 4.99 changed to 5.12
    • Malpractice RVU 0.45 changed to 0.48
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $290.87changed to$292.29

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 4.94 changed to 4.99
    • Malpractice RVU 0.47 changed to 0.45

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $255.19changed to$290.87

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 4.87 changed to 4.94
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $223.14changed to$255.19

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 4.90 changed to 4.87
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $224.71changed to$223.14

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 4.93 changed to 4.90

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $223.59changed to$224.71

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $220.45changed to$223.59

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 4.89 changed to 4.93
    • Malpractice RVU 0.48 changed to 0.47
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $218.16changed to$220.45

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 5.38 changed to 4.89
    • Malpractice RVU 0.50 changed to 0.48
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $218.16

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$323.83$302.55RVU26D
2026-07-01$323.83$302.55RVU26C
2026-04-01$323.83$302.55RVU26B
2026-01-01$323.83$302.55RVU26A
2025-10-01$299.32$299.97RVU25D
2025-07-01$299.32$299.97RVU25C
2025-04-01$299.32$299.97RVU25B
2025-01-01$299.32$299.97RVU25A
2024-10-01$303.02$302.68RVU24D
2024-07-01$303.02$302.68RVU24C
2024-04-01$303.02$302.68RVU24B
2024-03-09$303.02$302.68RVU24AR
2024-01-01$298.07$297.74RVU24A
2023-10-01$305.29$303.58RVU23D
2023-07-01$303.97$302.27RVU23C
2023-04-01$303.97$302.27RVU23B
2023-01-01$303.97$302.27RVU23A
2022-10-01$305.51$302.72RVU22D
2022-07-01$305.51$302.72RVU22C
2022-04-01$305.51$302.72RVU22B
2022-01-01$305.51$302.72RVU22A
2021-10-01$303.49$300.67RVU21D
2021-07-01$303.49$300.67RVU21C
2021-04-01$303.49$300.67RVU21B
2021-01-01$303.49$300.67RVU21A
2020-10-01$298.65$297.19RVU20D
2020-07-01$298.65$297.19RVU20C
2020-04-01$298.65$297.19RVU20B
2020-01-01$298.65$297.19RVU20A
2019-10-01$292.29$292.29RVU19D
2019-07-01$292.29$292.29RVU19C
2019-04-01$292.29$292.29RVU19B
2019-01-01$292.29$292.29RVU19A
2018-10-01$290.87$292.69RVU18D
2018-07-01$290.87$292.69RVU18C
2018-04-01$290.87$292.69RVU18B
2018-01-01$290.87$292.69RVU18AR1
2017-10-01$255.19$256.72RVU17D
2017-07-01$255.19$256.72RVU17C
2017-04-01$255.19$256.72RVU17B
2017-01-01$255.19$256.72RVU17A
2016-10-01$223.14$224.40RVU16D
2016-07-01$223.14$224.40RVU16C
2016-04-01$223.14$224.40RVU16B
2016-01-01$223.14$224.40RVU16A
2015-10-01$224.71$225.72RVU15D
2015-07-01$224.71$225.72RVU15C
2015-04-01$223.59$224.60RVU15B
2015-01-01$223.59$224.60RVU15A
2014-10-01$220.45$221.69RVU14D
2014-07-01$220.45$221.69RVU14C
2014-04-01$220.45$221.69RVU14B
2014-01-01$220.45$221.69RVU14A
2013-10-01$218.16$219.31RVU13D
2013-07-01$218.16$219.31RVU13C
2013-04-01$218.16$219.31RVU13B
2013-01-01$218.16$219.31RVU13AR

Price 27767 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

27767 billing questions

How is this distinguished from 27768?

Use 27767 when the posterior malleolus fracture is treated without manipulation. Use 27768 when the provider manipulates the fracture as part of closed treatment.

When is 27769 more appropriate?

Use 27769 when the posterior malleolus fracture is treated operatively with open fixation, rather than by closed fracture care.

Does the 90-day global include related follow-up care?

Yes. CMS includes the day-before preoperative visit and 90 days of related postoperative care in this code's global period.

How should bilateral treatment be reported?

For bilateral treatment, report modifier 50; CMS pays the bilateral procedure at 150%.

What documentation supports reporting 27767?

Document the posterior malleolus fracture, the closed treatment plan, and that no manipulation was performed. If the provider manipulates the fracture, consider 27768 instead.

Can an assistant or co-surgeon be reported?

CMS does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 27767PPRRVU2026_Oct_nonQPP.csv, line 3,044 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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