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CPT code 27818: Ankle fracture care, trimalleolar, with manipulation2026 Medicare rate & RVUs in North Carolina

Reports closed reduction and treatment of a trimalleolar ankle fracture when the physician manipulates the fracture to restore alignment.

CMS RVU26DEffective Oct 1, 2026One payment locality3.4K Medicare services in 2024

In North Carolina, Medicare pays $545.81 for 27818 in the office and $444.53 when it’s performed in a hospital or facility.

$545.81Office (non-facility)
$444.53Hospital or facility
−6.7%vs the national office rate ($584.85)

Check a contract rate as a % of Medicare · 27818 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 27818 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Carolina
  2. What 27818 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 27818 covers

Code 27818 represents closed reduction and treatment of a trimalleolar ankle fracture: a fracture involving the medial, lateral, and posterior malleoli. The physician manipulates the ankle to restore alignment without surgically exposing the fracture, then immobilizes it as part of the treatment. Orthopedic surgeons commonly perform this service in a hospital or other setting where the fracture is managed.

Choose this code when the fracture pattern is trimalleolar and manipulation is performed; a splint or cast alone does not establish that manipulation occurred. Document the fracture pattern, reduction maneuver, and resulting alignment. CMS assigns a 90-day major-surgery global period, including the day before surgery and 90 days of related postoperative care. In a same-session multiple-procedure situation, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with 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 27818

Across 109 of 109 payment localities, the office rate for 27818 runs from $514.16 in Arkansas to $743.98 in San Benito County, CA. North Carolina pays $545.81. The RVUs are the same everywhere; the geographic indexes change the dollars.

27818 in North Carolina vs other payment areas
  1. North Carolina · this page$545.81
  2. Los Angeles, CA · California$643.89+$98.08
  3. Washington, DC area · District of Columbia$663.25+$117.44
  4. Miami, FL · Florida$663.35+$117.54
  5. Chicago, IL · Illinois$642.00+$96.19
  6. Manhattan, NY · New York$679.13+$133.32
  7. Alaska · Alaska$682.04+$136.23

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

Every other payment area

27818 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$522.01$427.03
ArkansasArkansas$514.16$420.91
ArizonaArizona$567.75$462.56
Bakersfield, CACalifornia$606.39$487.41
Chico, CACalifornia$602.97$484.00
El Centro, CACalifornia$603.18$484.20
Fresno, CACalifornia$602.97$484.00
Hanford, CACalifornia$602.97$484.00

27818 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.

$514.16

$682.04

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

View every state and territory as a table
27818 office rate range by state
State / territoryOffice rate rangeLocalities
AK$682.041
AL$522.011
AR$514.161
AZ$567.751
CA$602.97–$743.9829
CO$600.831
CT$624.871
DC$663.251
DE$577.271
FL$590.11–$663.353
GA$554.23–$599.522
GU$616.281
HI$616.281
IA$529.271
ID$534.231
IL$577.23–$642.004
IN$537.281
KS$529.801
KY$541.591
LA$541.96–$569.422
MA$598.30–$657.262
MD$587.57–$663.253
ME$540.45–$566.222
MI$559.11–$600.972
MN$565.831
MO$534.40–$567.763
MS$524.231
MT$584.771
NC$545.811
ND$560.051
NE$531.341
NH$594.301
NJ$629.23–$656.602
NM$563.551
NV$578.241
NY$554.56–$700.105
OH$554.061
OK$537.261
OR$571.02–$616.832
PA$553.22–$610.912
PR$588.161
RI$595.671
SC$551.401
SD$557.131
TN$532.971
TX$549.69–$601.218
UT$559.131
VA$566.49–$663.252
VI$588.161
VT$560.651
WA$596.24–$667.682
WI$540.931
WV$555.981
WY$573.991

See 27818 in every payment locality

How the 27818 rate is calculated

Each of 27818’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 · 27818

RVUs × geographic indexes × conversion factor

Office or facility?

Work5.55

5.55 RVUs× 1.000 GPCI

Practice expense10.71

10.71 RVUs× 1.000 GPCI

Malpractice1.25

1.25 RVUs× 1.000 GPCI

Adjusted RVUs

17.5100

Conversion factor

$33.4009

Medicare rate

$584.85

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

3,057

Code
27818
Physician work
5.55
Practice expense
10.71
Malpractice
1.25

GPCI2026.csv

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for 27818 in North Carolina
ComponentRVULocality factorAdjusted
Physician work5.55× 1.0005.5500
Practice expense10.71× 0.9339.9924
Malpractice1.25× 0.6390.7988
Total RVUs16.3412
Conversion factor× 33.4009

Office rate, North Carolina$545.81

Office: (5.55 × 1 + 10.71 × 0.933 + 1.25 × 0.639) × $33.4009 = $545.81

Facility: (5.55 × 1 + 7.46 × 0.933 + 1.25 × 0.639) × $33.4009 = $444.53

Open 27818 in the RVU calculator

Payment rules and modifiers for 27818

27818 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 27818

Ankle fracture care, trimalleolar, with 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 · 27818

Ankle fracture care, trimalleolar, with 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

27818 without 50 · national office

$584.85

Ankle fracture care, trimalleolar, with manipulation

27818-50 · Bilateral: 150%

$877.28

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 27818

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

Codes related to 27818
CodeHow it relatesOffice range, North Carolina
Same family
27816Ankle fracture care, trimalleolar, no manipulationClosed treatment of a trimalleolar fracture without manipulation.$357.11
27810Ankle fracture treatment, bimalleolar, with manipulationClosed treatment with manipulation for a bimalleolar rather than trimalleolar fracture.$524.60
27808Ankle fracture care, bimalleolar, without manipulationClosed treatment without manipulation for a bimalleolar fracture.$357.72
Used instead
27822Ankle fracture surgery, without posterior lip fixationOpen treatment of a trimalleolar fracture without fixation of the posterior lip.No office rate
27823Ankle fracture repair, posterior lip fixationOpen treatment of a trimalleolar fracture with fixation of the posterior lip.No office rate
27814Ankle fracture, open bimalleolar treatmentOpen treatment applies to a bimalleolar rather than trimalleolar fracture.No office rate

How 27818 has changed in North Carolina

27818 · Office / nonfacility

$545.81

Effective 2026-10-01

The base rate is $79.43 higher than on 2025-10-01, moving from $466.38 to $545.81 (17.0%).

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

    $466.38changed to$545.81

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 5.69 changed to 5.55
    • Practice expense RVU 8.60 changed to 10.71
    • Malpractice RVU 1.15 changed to 1.25
    • 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

    $475.77changed to$466.38

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 8.45 changed to 8.60
    • Malpractice RVU 1.17 changed to 1.15

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $468.00changed to$475.77

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $480.39changed to$468.00

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 8.25 changed to 8.45
    • Malpractice RVU 1.13 changed to 1.17
    • Practice expense GPCI 0.927 changed to 0.926
    • Malpractice GPCI 0.742 changed to 0.665

  5. January 1, 2023

    RVU23A

    $481.39changed to$480.39

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 7.87 changed to 8.25
    • Malpractice RVU 1.12 changed to 1.13
    • 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

    $479.63changed to$481.39

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 7.71 changed to 7.87
    • Malpractice RVU 1.10 changed to 1.12

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $477.12changed to$479.63

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 7.21 changed to 7.71
    • Malpractice RVU 1.09 changed to 1.10
    • 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

    $472.78changed to$477.12

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 7.27 changed to 7.21
    • Malpractice RVU 0.95 changed to 1.09
    • 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

    $470.92changed to$472.78

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 7.23 changed to 7.27

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $467.66changed to$470.92

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 7.13 changed to 7.23
    • Malpractice RVU 0.96 changed to 0.95
    • Malpractice GPCI 0.732 changed to 0.695

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $468.48changed to$467.66

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 7.15 changed to 7.13
    • Malpractice RVU 0.97 changed to 0.96
    • 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

    $470.39changed to$468.48

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 7.14 changed to 7.15
    • Malpractice RVU 0.99 changed to 0.97

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $468.05changed to$470.39

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $466.00changed to$468.05

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 7.09 changed to 7.14
    • Malpractice RVU 1.00 changed to 0.99
    • 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

    $465.69changed to$466.00

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 7.84 changed to 7.09
    • Malpractice RVU 1.05 changed to 1.00
    • 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: $465.69

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$545.81$444.53RVU26D
2026-07-01$545.81$444.53RVU26C
2026-04-01$545.81$444.53RVU26B
2026-01-01$545.81$444.53RVU26A
2025-10-01$466.38$415.46RVU25D
2025-07-01$466.38$415.46RVU25C
2025-04-01$466.38$415.46RVU25B
2025-01-01$466.38$415.46RVU25A
2024-10-01$475.77$423.99RVU24D
2024-07-01$475.77$423.99RVU24C
2024-04-01$475.77$423.99RVU24B
2024-03-09$475.77$423.99RVU24AR
2024-01-01$468.00$417.07RVU24A
2023-10-01$480.39$428.87RVU23D
2023-07-01$480.39$428.87RVU23C
2023-04-01$480.39$428.87RVU23B
2023-01-01$480.39$428.87RVU23A
2022-10-01$481.39$430.97RVU22D
2022-07-01$481.39$430.97RVU22C
2022-04-01$481.39$430.97RVU22B
2022-01-01$481.39$430.97RVU22A
2021-10-01$479.63$429.12RVU21D
2021-07-01$479.63$429.12RVU21C
2021-04-01$479.63$429.12RVU21B
2021-01-01$479.63$429.12RVU21A
2020-10-01$477.12$428.45RVU20D
2020-07-01$477.12$428.45RVU20C
2020-04-01$477.12$428.45RVU20B
2020-01-01$477.12$428.45RVU20A
2019-10-01$472.78$423.46RVU19D
2019-07-01$472.78$423.46RVU19C
2019-04-01$472.78$423.46RVU19B
2019-01-01$472.78$423.46RVU19A
2018-10-01$470.92$421.66RVU18D
2018-07-01$470.92$421.66RVU18C
2018-04-01$470.92$421.66RVU18B
2018-01-01$470.92$421.66RVU18AR1
2017-10-01$467.66$420.55RVU17D
2017-07-01$467.66$420.55RVU17C
2017-04-01$467.66$420.55RVU17B
2017-01-01$467.66$420.55RVU17A
2016-10-01$468.48$421.53RVU16D
2016-07-01$468.48$421.53RVU16C
2016-04-01$468.48$421.53RVU16B
2016-01-01$468.48$421.53RVU16A
2015-10-01$470.39$422.93RVU15D
2015-07-01$470.39$422.93RVU15C
2015-04-01$468.05$420.83RVU15B
2015-01-01$468.05$420.83RVU15A
2014-10-01$466.00$420.08RVU14D
2014-07-01$466.00$420.08RVU14C
2014-04-01$466.00$420.08RVU14B
2014-01-01$466.00$420.08RVU14A
2013-10-01$465.69$417.12RVU13D
2013-07-01$465.69$417.12RVU13C
2013-04-01$465.69$417.12RVU13B
2013-01-01$465.69$417.12RVU13AR

Price 27818 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

27818 billing questions

How does 27818 differ from 27816?

Both address closed treatment of a trimalleolar ankle fracture. Report 27818 when manipulation is performed; 27816 is the corresponding code when it is not.

How does 27818 differ from 27810?

The fracture pattern is the key distinction: 27818 is for a trimalleolar fracture, while 27810 is for a bimalleolar fracture treated with manipulation.

Can cast or splint application be billed separately?

Routine immobilization is part of the fracture treatment represented by 27818. Do not report a separate cast or splint application for that same treatment.

What documentation supports reporting manipulation?

Document the trimalleolar fracture pattern and the reduction maneuver used to restore alignment, including the result when known. A note that only describes applying a splint or cast does not establish manipulation.

How is bilateral treatment reported?

When the service is performed bilaterally, report modifier 50; CMS pays the bilateral procedure at 150%.

Can an assistant or co-surgeon be reported?

CMS applies a statutory restriction on assistant-at-surgery payment 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 27818PPRRVU2026_Oct_nonQPP.csv, line 3,057 (RVU26D)
Geographic factors for North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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