CPT code 27828: Pilon fracture repair, with fibular fixation2026 Medicare rate & RVUs in Missouri
Open fixation of a distal tibial pilon fracture with fibular fixation, reported when operative treatment addresses both the tibial plafond injury and fibula.
CMS doesn’t publish an office rate for 27828 in Missouri.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 27828 covers
An orthopedic surgeon typically reports this service for open operative treatment of a distal tibial pilon or tibial plafond fracture when the fibula is also fixed. These injuries often require hospital operating-room care, particularly when the fracture involves the weight-bearing surface of the ankle. The code accounts for internal fixation of the tibia and, when performed, fixation of the fibula as part of the pilon fracture treatment.
Select this code when the operative report supports open treatment of the distal tibial fracture and documents fibular fixation; use the related pilon code 27827 when fibular fixation is not performed. Documentation should identify the fracture sites, open approach, and fixation performed. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure setting, 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 and co-surgeons are permitted; team surgery is 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.
Where 27828 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $1,196.35 |
| Metropolitan St. Louis, MO | Unavailable | $1,206.00 |
| Rest of Missouri | Unavailable | $1,156.84 |
How the 27828 rate is calculated
Each of 27828’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 · 27828
RVUs × geographic indexes × conversion factor
Work17.97
17.97 RVUs× 1.000 GPCI
Practice expense15.22
15.22 RVUs× 1.000 GPCI
Malpractice3.64
3.64 RVUs× 1.000 GPCI
Adjusted RVUs
36.8300
Conversion factor
$33.4009
Medicare rate
$1,230.16
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 27828
27828 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 27828
Pilon fracture repair, with fibular fixation
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 2 | Permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 27828
Pilon fracture repair, with fibular fixation
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
27828 without 50 · national facility
$1,230.16
Pilon fracture repair, with fibular fixation
27828-50 · Bilateral: 150%
$1,845.24
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).
27828 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 27827Pilon fracture repairTibia only
- Use 27827 for open pilon fracture treatment without fibular fixation. When the fibula is fixed as part of the treatment, 27828 is the distinguishing code.
- 27826Fracture repairPosterior malleolus
- 27826 describes open treatment of a distal fibular fracture. It does not describe the combined pilon fracture treatment with fibular fixation represented by 27828.
- 27829Syndesmosis repairDistal tibiofibular joint
- 27829 addresses open treatment of a distal tibiofibular syndesmosis disruption. Choose based on the operative condition treated, rather than treating syndesmosis repair as pilon fracture fixation.
- 27822Ankle fracture surgeryWithout posterior lip fixation
- 27822 is for open treatment of a trimalleolar ankle fracture without fixation of the posterior lip. It is not the pilon fracture code for distal tibial plafond involvement with fibular fixation.
27828 billing questions
How does 27828 differ from 27827?
Both apply to open treatment of a distal tibial pilon or plafond fracture. Use 27828 when the fibula is also fixed; 27827 applies when fibular fixation is not performed.
Can the internal fixation be reported separately?
No separate fixation service is represented by this code; internal fixation is included in the pilon fracture treatment.
What should the operative report document?
Document the distal tibial pilon or plafond fracture, the open treatment, and the fibular fixation performed. The report should make clear that the fibular work occurred as part of the fracture treatment.
What is included in the global period?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How does Medicare handle another procedure performed in the same session?
The highest-valued procedure is paid in full, and other procedures are paid at 50%. Bilateral reporting with modifier 50 is paid at 150%.
May an assistant or co-surgeon be reported?
Assistant-at-surgery payment and co-surgeons are permitted for this code. Team surgery is 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
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