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Billing code 27509: Femur fracture fixationMedicare rate & RVUs

Percutaneous fixation of a femoral shaft fracture is reported when the surgeon stabilizes the fracture through small incisions without open exposure.

CMS RVU26DEffective Oct 1, 2026109 payment localities343 Medicare services in 2024

Medicare pays $652.65 for 27509 nationally in a facility.

Medicare rate · 27509

Femur fracture fixation

Swap in your local Medicare rate.

Work RVUs
7.94
Total RVUs
19.54
Global days
090

National rate · 2026

$652.65

Facility setting, before claim adjustments.

See every locality for 27509 → · Billed by an NP, PA or therapist? →

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

On this page 10 sections
  1. Medicare rate
  2. What 27509 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 27509 covers

An orthopedic surgeon uses percutaneous fixation to stabilize a femoral shaft fracture by placing fixation devices through small incisions, rather than exposing the fracture through an open approach. The service may involve manipulation to align the fracture before fixation. It is typically performed in a hospital or ambulatory surgical setting; the operative report should identify the shaft fracture, the percutaneous approach, and the fixation performed.

Choose this code when the operative method is percutaneous skeletal fixation, not closed fracture care alone or open fixation. The documentation should support the fracture location and describe the approach and stabilization. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. An assistant is paid only when medical necessity is documented; 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.

Where 27509 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

27509 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$587.09
Alaska*Unavailable$781.94
ArizonaUnavailable$634.38
ArkansasUnavailable$578.95
AtlantaUnavailable$669.91
AustinUnavailable$666.12
BakersfieldUnavailable$667.89
Baltimore/Surr. CntysUnavailable$694.27
BeaumontUnavailable$618.84
BrazoriaUnavailable$639.59

27509 rates by state

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

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Local rates. Clear comparisons.

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

View every state and territory as a table
27509 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 27509 rate is calculated

Each of 27509’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 · 27509

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 7.94Practice expense 9.94Malpractice 1.66

19.5400 adjusted RVUs×$33.4009 conversion factor=$652.65

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 27509

27509 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 27509

Femur fracture fixation

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)0Not paid without supporting documentation.
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 · 27509

Femur fracture 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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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

27509 without 50 · national facility

$652.65

Femur fracture fixation

27509-50 · Bilateral: 150%

$978.98

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

27509 compared with similar codes

Compare codes

27509 vs 27506 vs 27507 vs 27502: national Medicare rates

Swap in your local Medicare rate.

  • 27509
    Femur fracture fixation · 7.94 wRVU
    —
  • 27506
    Femur fracture repair · 19.16 wRVU
    —
  • 27507
    Femur fracture repair · 14.12 wRVU
    —
  • 27502
    Femur fracture care · 11.08 wRVU
    —

How to choose

27506Femur fracture repair
Use 27509 when skeletal fixation is performed percutaneously. Use 27506 for open treatment with an intramedullary implant.
27507Femur fracture repair
Use 27507 for open femoral shaft fixation with a plate-and-screw construct; 27509 represents percutaneous skeletal fixation.
27502Femur fracture care
27502 represents closed treatment with manipulation, with or without traction. Choose 27509 when the surgeon performs percutaneous skeletal fixation.

Codes related to 27509

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

Codes related to 27509
CodeHow it relatesNational office range
Used instead
27506Femur fracture repairOpen femoral shaft fixation using an intramedullary implant rather than a percutaneous approach.No office rate
27507Femur fracture repairOpen femoral shaft fixation using a plate-and-screw construct.No office rate
27502Femur fracture careClosed treatment of a femoral shaft fracture with manipulation, without percutaneous skeletal fixation.No office rate
27500Femur fracture careClosed treatment of a femoral shaft fracture without manipulation or percutaneous fixation.$507.36–$720.69

27509 billing questions

How is this code different from open femoral shaft fixation?

Use 27509 for percutaneous skeletal fixation. Open treatment with an intramedullary implant or a plate-and-screw construct is described by 27506 or 27507, respectively.

Can it be reported for closed fracture treatment without fixation?

No. This code describes percutaneous stabilization; closed treatment without skeletal fixation is represented by a different femoral shaft fracture code.

What documentation supports choosing this code?

The operative report should identify the femoral shaft fracture and document the percutaneous approach and skeletal fixation performed. Include any manipulation used to align the fracture.

How is bilateral treatment reported?

CMS identifies this as a bilateral procedure; reporting modifier 50 is paid at 150%.

Can an assistant surgeon or co-surgeon be reported?

Assistant-at-surgery payment requires documentation of medical necessity. CMS does not permit co-surgeons or team surgery for this code.

What postoperative care is included?

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

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 27509PPRRVU2026_Oct_nonQPP.csv, line 2,929 (RVU26D)

Open CMS sourceHow we calculate rates

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