CPT code 27786: Ankle fracture care, distal fibula, without manipulation2026 Medicare rate & RVUs in North Carolina

Report this service for nonoperative treatment of a distal fibular fracture at the lateral malleolus when the provider does not manipulate the fracture.

CMS RVU26DEffective Oct 1, 2026One payment locality14.3K Medicare services in 2024

In North Carolina, Medicare pays $327.87 for 27786 in the office and $275.20 when it’s performed in a hospital or facility.

$327.87Office (non-facility)
$275.20Hospital or facility
−6.3%vs the national office rate ($350.04)

Check a contract rate as a % of Medicare · 27786 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 27786 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Carolina
  2. What 27786 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 27786 covers

This code covers closed, nonoperative care of a fracture at the distal fibula, or lateral malleolus, when the provider treats it without manipulating the fracture. Orthopedic surgeons and other clinicians who provide fracture care may use it for a stable lateral malleolus fracture managed with immobilization, such as a cast or brace. The fracture pattern and the treatment actually performed distinguish this service from reduction or operative repair.

Choose the code based on the documented fracture site and whether manipulation or surgery was performed. The record should identify the distal fibular fracture and support treatment without manipulation. CMS assigns a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. If this code is performed with other procedures in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple procedure reduction. For bilateral treatment, modifier 50 is paid at 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 North Carolina compares for 27786

Across 109 of 109 payment localities, the office rate for 27786 runs from $308.33 in Arkansas to $455.82 in San Benito County, CA. North Carolina pays $327.87. The RVUs are the same everywhere; the geographic indexes change the dollars.

27786 in North Carolina vs other payment areas
  1. North Carolina · this page$327.87
  2. Los Angeles, CA · California$390.79+$62.92
  3. Washington, DC area · District of Columbia$399.00+$71.13
  4. Miami, FL · Florida$387.21+$59.34
  5. Chicago, IL · Illinois$375.26+$47.39
  6. Manhattan, NY · New York$404.77+$76.90
  7. Alaska · Alaska$406.24+$78.37

Other areas in North Carolina first, then benchmark localities. Bars start at $0.

Every other payment area

27786 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$312.99$263.60
ArkansasArkansas$308.33$259.84
ArizonaArizona$340.20$285.50
Bakersfield, CACalifornia$367.30$305.43
Chico, CACalifornia$365.79$303.92
El Centro, CACalifornia$365.88$304.01
Fresno, CACalifornia$365.79$303.92
Hanford, CACalifornia$365.79$303.92

27786 rates by state

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

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.

$308.33

$410.81

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

View every state and territory as a table
27786 office rate range by state
State / territoryOffice rate rangeLocalities
AK$406.241
AL$312.991
AR$308.331
AZ$340.201
CA$365.79–$455.8229
CO$362.231
CT$373.801
DC$399.001
DE$345.911
FL$348.83–$387.213
GA$328.25–$357.702
GU$374.481
HI$374.481
IA$319.291
ID$321.831
IL$339.85–$375.264
IN$323.701
KS$318.651
KY$322.561
LA$322.40–$338.702
MA$360.34–$397.442
MD$352.35–$399.003
ME$324.52–$341.282
MI$332.03–$354.232
MN$344.121
MO$317.31–$338.853
MS$312.831
MT$350.011
NC$327.871
ND$339.331
NE$320.821
NH$357.371
NJ$377.23–$394.862
NM$334.261
NV$347.261
NY$332.99–$415.975
OH$329.841
OK$321.001
OR$343.75–$372.952
PA$329.88–$364.882
PR$352.341
RI$357.671
SC$329.571
SD$338.071
TN$320.411
TX$327.72–$361.748
UT$334.171
VA$340.76–$399.002
VI$352.341
VT$338.791
WA$359.40–$404.722
WI$327.741
WV$327.191
WY$345.351

See 27786 in every payment locality

How the 27786 rate is calculated

Each of 27786’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 · 27786

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.94

2.94 RVUs× 1.000 GPCI

Practice expense7.00

7.00 RVUs× 1.000 GPCI

Malpractice0.54

0.54 RVUs× 1.000 GPCI

Adjusted RVUs

10.4800

Conversion factor

$33.4009

Medicare rate

$350.04

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

The exact North Carolina inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

3,050

Code
27786
Physician work
2.94
Practice expense
7.00
Malpractice
0.54

GPCI2026.csv

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for 27786 in North Carolina
ComponentRVULocality factorAdjusted
Physician work2.94× 1.0002.9400
Practice expense7.00× 0.9336.5310
Malpractice0.54× 0.6390.3451
Total RVUs9.8161
Conversion factor× 33.4009

Office rate, North Carolina$327.87

Office: (2.94 × 1 + 7 × 0.933 + 0.54 × 0.639) × $33.4009 = $327.87

Facility: (2.94 × 1 + 5.31 × 0.933 + 0.54 × 0.639) × $33.4009 = $275.20

Open 27786 in the RVU calculator

Payment rules and modifiers for 27786

27786 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 27786

Ankle fracture care, distal fibula, without 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 · 27786

Ankle fracture care, distal fibula, without 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

27786 without 50 · national office

$350.04

Ankle fracture care, distal fibula, without manipulation

27786-50 · Bilateral: 150%

$525.06

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

How 27786 has changed in North Carolina

27786 · Office / nonfacility

$327.87

Effective 2026-10-01

The base rate is $29.48 higher than on 2025-10-01, moving from $298.39 to $327.87 (9.9%).

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

    $298.39changed to$327.87

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.02 changed to 2.94
    • Practice expense RVU 6.32 changed to 7.00
    • Malpractice RVU 0.53 changed to 0.54
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.665 changed to 0.639

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $304.82changed to$298.39

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 6.24 changed to 6.32
    • Malpractice RVU 0.54 changed to 0.53

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $299.85changed to$304.82

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $306.91changed to$299.85

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 6.08 changed to 6.24
    • Practice expense GPCI 0.927 changed to 0.926
    • Malpractice GPCI 0.742 changed to 0.665
  5. January 1, 2023

    RVU23A

    $309.22changed to$306.91

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 5.88 changed to 6.08
    • Malpractice RVU 0.56 changed to 0.54
    • Practice expense GPCI 0.928 changed to 0.927
    • Malpractice GPCI 0.819 changed to 0.742

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $308.33changed to$309.22

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 5.80 changed to 5.88
    • Malpractice RVU 0.53 changed to 0.56

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $306.66changed to$308.33

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 5.45 changed to 5.80
    • Malpractice RVU 0.54 changed to 0.53
    • Practice expense GPCI 0.930 changed to 0.928
    • Malpractice GPCI 0.757 changed to 0.819

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $304.22changed to$306.66

    • Conversion factor 36.0391 changed to 36.0896
    • Malpractice RVU 0.50 changed to 0.54
    • Practice expense GPCI 0.931 changed to 0.930
    • Malpractice GPCI 0.695 changed to 0.757

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $306.23changed to$304.22

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 5.52 changed to 5.45

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $304.14changed to$306.23

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 5.45 changed to 5.52
    • Malpractice RVU 0.52 changed to 0.50
    • Malpractice GPCI 0.732 changed to 0.695

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $304.57changed to$304.14

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 5.47 changed to 5.45
    • Practice expense GPCI 0.930 changed to 0.931
    • Malpractice GPCI 0.768 changed to 0.732

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $306.34changed to$304.57

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 5.49 changed to 5.47

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $304.81changed to$306.34

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $302.53changed to$304.81

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 5.43 changed to 5.49
    • Practice expense GPCI 0.929 changed to 0.930
    • Malpractice GPCI 0.732 changed to 0.768

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $305.70changed to$302.53

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 6.03 changed to 5.43
    • Malpractice RVU 0.54 changed to 0.52
    • Practice expense GPCI 0.927 changed to 0.929
    • Malpractice GPCI 0.695 changed to 0.732

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $305.70

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$327.87$275.20RVU26D
2026-07-01$327.87$275.20RVU26C
2026-04-01$327.87$275.20RVU26B
2026-01-01$327.87$275.20RVU26A
2025-10-01$298.39$273.23RVU25D
2025-07-01$298.39$273.23RVU25C
2025-04-01$298.39$273.23RVU25B
2025-01-01$298.39$273.23RVU25A
2024-10-01$304.82$279.24RVU24D
2024-07-01$304.82$279.24RVU24C
2024-04-01$304.82$279.24RVU24B
2024-03-09$304.82$279.24RVU24AR
2024-01-01$299.85$274.68RVU24A
2023-10-01$306.91$281.47RVU23D
2023-07-01$306.91$281.47RVU23C
2023-04-01$306.91$281.47RVU23B
2023-01-01$306.91$281.47RVU23A
2022-10-01$309.22$284.17RVU22D
2022-07-01$309.22$284.17RVU22C
2022-04-01$309.22$284.17RVU22B
2022-01-01$309.22$284.17RVU22A
2021-10-01$308.33$282.43RVU21D
2021-07-01$308.33$282.43RVU21C
2021-04-01$308.33$282.43RVU21B
2021-01-01$308.33$282.43RVU21A
2020-10-01$306.66$281.16RVU20D
2020-07-01$306.66$281.16RVU20C
2020-04-01$306.66$281.16RVU20B
2020-01-01$306.66$281.16RVU20A
2019-10-01$304.22$277.38RVU19D
2019-07-01$304.22$277.38RVU19C
2019-04-01$304.22$277.38RVU19B
2019-01-01$304.22$277.38RVU19A
2018-10-01$306.23$276.74RVU18D
2018-07-01$306.23$276.74RVU18C
2018-04-01$306.23$276.74RVU18B
2018-01-01$306.23$276.74RVU18AR1
2017-10-01$304.14$276.08RVU17D
2017-07-01$304.14$276.08RVU17C
2017-04-01$304.14$276.08RVU17B
2017-01-01$304.14$276.08RVU17A
2016-10-01$304.57$276.26RVU16D
2016-07-01$304.57$276.26RVU16C
2016-04-01$304.57$276.26RVU16B
2016-01-01$304.57$276.26RVU16A
2015-10-01$306.34$277.26RVU15D
2015-07-01$306.34$277.26RVU15C
2015-04-01$304.81$275.88RVU15B
2015-01-01$304.81$275.88RVU15A
2014-10-01$302.53$274.57RVU14D
2014-07-01$302.53$274.57RVU14C
2014-04-01$302.53$274.57RVU14B
2014-01-01$302.53$274.57RVU14A
2013-10-01$305.70$276.05RVU13D
2013-07-01$305.70$276.05RVU13C
2013-04-01$305.70$276.05RVU13B
2013-01-01$305.70$276.05RVU13AR

Price 27786 for an earlier date of service

Where the North Carolina rate applies

North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Advance
  • Ahoskie
  • Alamance
  • Albemarle
  • Alexis
  • Alliance
  • Altamahaw

Browse all communities in North Carolina

27786 billing questions

How is this code different from 27788?

Both describe closed treatment of a distal fibular fracture at the lateral malleolus. Use 27786 when the provider does not manipulate the fracture; 27788 describes treatment with manipulation.

When is 27792 more appropriate?

Use 27792 when the distal fibular fracture is treated operatively through an open approach. This code describes closed treatment without manipulation.

Can modifier 50 be reported for bilateral fractures?

Yes. CMS lists this as a bilateral procedure; modifier 50 is paid at 150% when the service is performed bilaterally.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

What documentation supports choosing this code?

Document the distal fibular or lateral malleolar fracture and that it was treated closed without manipulation. If the treatment involves manipulation or open repair, choose the corresponding code instead.

Can an assistant or co-surgeon be paid for this service?

CMS lists a statutory restriction on assistant-at-surgery payment. Co-surgeons and team surgery are not permitted for this code.

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 27786PPRRVU2026_Oct_nonQPP.csv, line 3,050 (RVU26D)
Geographic factors for North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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