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Billing code 27769: Ankle fracture repairMedicare rate & RVUs

Report this code for operative treatment of a posterior malleolus ankle fracture through an open approach, with internal fixation when performed.

CMS RVU26DEffective Oct 1, 2026109 payment localities227 Medicare services in 2024

Medicare pays $675.70 for 27769 nationally in a facility.

Medicare rate · 27769

Ankle fracture repair

Swap in your local Medicare rate.

Work RVUs
9.89
Total RVUs
20.23
Global days
090

National rate · 2026

$675.70

Facility setting, before claim adjustments.

See every locality for 27769 → · 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 27769 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 27769 covers

This code describes open operative treatment of a fracture of the posterior malleolus, the back portion of the distal tibia at the ankle. An orthopedic surgeon exposes the fracture and treats it through the operative approach; internal fixation is included when used. The service is typically performed in a hospital or ambulatory surgery center, rather than as closed fracture care in an office.

Choose the code based on open treatment of the posterior malleolus, not merely on whether fixation is used. The operative report should identify the posterior malleolus fracture and document the open approach and treatment performed. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. For bilateral procedures, modifier 50 is paid at 150%. Medicare does not pay an assistant at surgery for this code; 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 27769 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

27769 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$612.20
Alaska*Unavailable$829.50
ArizonaUnavailable$657.56
ArkansasUnavailable$604.37
AtlantaUnavailable$694.39
AustinUnavailable$685.07
BakersfieldUnavailable$683.09
Baltimore/Surr. CntysUnavailable$716.99
BeaumontUnavailable$645.87
BrazoriaUnavailable$661.35

27769 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
27769 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 27769 rate is calculated

Each of 27769’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 · 27769

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 9.89Practice expense 8.37Malpractice 1.97

20.2300 adjusted RVUs×$33.4009 conversion factor=$675.70

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

Payment rules and modifiers for 27769

27769 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 27769

Ankle fracture repair

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 · 27769

Ankle fracture repair

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

27769 without 50 · national facility

$675.70

Ankle fracture repair

27769-50 · Bilateral: 150%

$1,013.55

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

27769 compared with similar codes

Compare codes

27769 vs 27767 vs 27768 vs 27823 vs 27766: national Medicare rates

Swap in your local Medicare rate.

  • 27769
    Ankle fracture repair · 9.89 wRVU
    —
  • 27767
    Ankle fracture care · 2.57 wRVU
    $321.65
  • 27768
    Ankle fracture treatment · 5.01 wRVU
    —
  • 27823
    Ankle fracture repair · 12.83 wRVU
    —
  • 27766
    Ankle fracture repair · 7.69 wRVU
    —

How to choose

27767Ankle fracture care
Use 27767 for closed treatment of a posterior malleolus fracture without manipulation; 27769 requires open treatment.
27768Ankle fracture treatment
Use 27768 for closed treatment with manipulation. Open operative treatment of the posterior malleolus is reported with 27769.
27823Ankle fracture repair
For open treatment of a trimalleolar fracture with fixation of the posterior lip, compare 27823 rather than separately coding the same posterior fixation with 27769.
27766Ankle fracture repair
27766 is for open treatment of a medial malleolus fracture; 27769 concerns the posterior malleolus.

Codes related to 27769

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

Codes related to 27769
CodeHow it relatesNational office range
Same family
27767Ankle fracture careClosed treatment of a posterior malleolus fracture without manipulation.$282.89–$420.80
27768Ankle fracture treatmentClosed treatment of a posterior malleolus fracture with manipulation.No office rate
Used instead
27823Ankle fracture repairOpen trimalleolar fracture treatment that includes fixation of the posterior lip.No office rate
Often billed with
27766Ankle fracture repairMay accompany treatment of a separate medial malleolus fracture component.No office rate
27792Ankle fracture surgeryMay accompany treatment of a separate lateral malleolus fracture component.No office rate

27769 billing questions

How does 27769 differ from 27767 and 27768?

27769 is for open treatment of a posterior malleolus fracture. Codes 27767 and 27768 describe closed treatment, with manipulation distinguishing 27768.

Is internal fixation separately reported with 27769?

Internal fixation, when performed as part of the open fracture treatment, is included in 27769. Do not separately report fixation for that same fracture treatment.

Can 27769 be reported for a trimalleolar fracture?

For a trimalleolar fracture treated with fixation of the posterior lip, compare the service with 27823, which describes open treatment that includes posterior lip fixation. Do not separately report the same posterior fixation as 27769.

What documentation supports reporting 27769?

The operative report should establish that the fracture involved the posterior malleolus and was treated through an open approach. It should also describe the treatment performed and any internal fixation used.

How does Medicare handle bilateral treatment and multiple procedures?

For bilateral procedures, modifier 50 is paid at 150%. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and the others are reduced to 50%.

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 27769PPRRVU2026_Oct_nonQPP.csv, line 3,046 (RVU26D)

Open CMS sourceHow we calculate rates

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