Billing code 27538: Knee fracture careMedicare rate & RVUs in Florida
Reports closed treatment without manipulation of a knee fracture involving the tibial intercondylar spine or tibial tuberosity.
Medicare pays $541.71–$606.74 for 27538 in the office in Florida, from Rest Of Florida to Miami. Which amount applies depends on the service address.
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 9 sections
What 27538 covers
Code 27538 covers closed management of a fracture involving the tibial intercondylar spine, also called the tibial eminence, or the tibial tuberosity. A common example is a tibial spine avulsion fracture managed without operative exposure or manipulation. An orthopedic or trauma surgeon may provide the treatment in a hospital, outpatient facility, or office setting, using immobilization such as a brace or cast as appropriate.
Select this code when the documented fracture site and treatment match those criteria; distinguish it from tibial plateau, patellar, and open-treatment codes. The record should identify the fracture location and closed plan without manipulation. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and others at 50%. For bilateral treatment reported with modifier 50, CMS pays 150%. Assistant-at-surgery payment requires documented medical necessity; 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 27538 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$541.71 to $606.74
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | $571.75 | $482.43 |
| Miami | $606.74 | $514.94 |
| Rest Of Florida | $541.71 | $457.41 |
How the 27538 rate is calculated
Each of 27538’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 · 27538
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.96Practice expense 10.11Malpractice 1.06
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 27538
27538 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 27538
Knee fracture care
| 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) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not 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 · 27538
Knee fracture care
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
27538 without 50 · national office
$538.76
Knee fracture care
27538-50 · Bilateral: 150%
$808.14
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).
27538 compared with similar codes
Compare codes
27538 vs 27540 vs 27530 vs 27532 vs 27520: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 27540Knee fracture repair
- Use 27538 for closed treatment without manipulation of the tibial spine or tuberosity fracture. Code 27540 describes open treatment of that fracture pattern.
- 27530Fracture treatment
- Code 27530 is for closed treatment without manipulation of a tibial plateau fracture, not a tibial spine or tuberosity fracture.
- 27532Fracture treatment
- Code 27532 addresses a tibial plateau fracture treated closed with manipulation. Code 27538 concerns a different fracture site and treatment without manipulation.
- 27520Patella fracture
- Code 27520 is for closed treatment of a patellar fracture without manipulation. Code 27538 applies to the tibial spine or tuberosity.
27538 billing questions
How does 27538 differ from 27540?
27538 is for closed treatment without manipulation. Code 27540 is for open treatment of the specified tibial spine or tuberosity fracture.
Can 27538 be reported for a tibial plateau fracture?
No. Codes 27530 and 27532 describe closed treatment of tibial plateau fractures; 27538 concerns the tibial intercondylar spine or tuberosity.
What documentation supports 27538?
Document the fracture site, the closed treatment plan, and that treatment was without manipulation. Imaging findings may help establish the specific fracture location.
Does the 90-day global include related follow-up care?
Yes. CMS includes the day-before preoperative visit and 90 days of related postoperative care in the global period.
How is bilateral treatment handled?
When the bilateral procedure is reported with modifier 50, CMS pays 150%.
When is assistant-at-surgery payment allowed?
CMS allows assistant-at-surgery payment only when medical necessity is documented. 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
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