$293.30
Both address closed treatment of a posterior malleolus fracture. Select 27768 when manipulation is performed; 27767 is for treatment without manipulation.
On this page
CMS RVU26D · Effective 2026-10-01
27768 Ankle fracture treatment Medicare reimbursement rates in Iowa
Closed treatment of a posterior malleolus fracture requiring manipulation to restore alignment, typically performed by an orthopedic surgeon in a facility setting. Compare 27768 office and facility rates across CMS payment localities in Iowa.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 27768 in Iowa?
Iowa has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$400.35
1 of 1 localities have a supported rate.
Payment area: Iowa
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Orthopedic fracture care
About 27768: Closed posterior malleolus fracture reduction
Closed treatment of a posterior malleolus fracture requiring manipulation to restore alignment, typically performed by an orthopedic surgeon in a facility setting.
This code describes closed management of a fracture involving the posterior portion of the distal tibia at the ankle when the clinician manipulates the fracture to improve alignment. An orthopedic surgeon typically performs the reduction, often using imaging to assess fracture position before and after manipulation. The fracture is managed without surgically exposing the bone; stabilization may follow the reduction.
Choose this code when the documented treatment includes manipulation, rather than closed care without manipulation or open fixation. The record should identify the posterior malleolus fracture and support the need for reduction, including the alignment findings and treatment performed. Medicare assigns a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. For bilateral treatment reported with modifier 50, payment is 150%. Assistant-at-surgery payment is restricted; co-surgeons and team surgery are not permitted.
CMS billing rules for 27768
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU5.01 · 38%
- Practice expense (office) RVU7.16 · 54%
- Malpractice RVU1.07 · 8%
42
Medicare services in 2024 · #5462 by national volume
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.
27768 compared with similar codes
Office rates for Iowa, from the same CMS release.
No office rate
27769 describes open treatment of a posterior malleolus fracture. Use 27768 for closed treatment that includes manipulation.
$508.85
27810 applies to closed treatment with manipulation of a bimalleolar ankle fracture. This code is specific to a posterior malleolus fracture.
Compare 27768 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Iowa →
Office / nonfacility
Unavailable
Facility
$400.35
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 27768 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
3,045
- Code
- 27768
- Physician work
- 5.01
- Practice expense
- 7.16
- Malpractice
- 1.07
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.01 | × 1.000 | 5.0100 |
| Practice expense | 7.16 | × 0.915 | 6.5514 |
| Malpractice | 1.07 | × 0.397 | 0.4248 |
| Total RVUs | 11.9862 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Iowa$400.35
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.01 | 1 |
| Practice expense | 7.16 | 0.915 |
| Malpractice | 1.07 | 0.397 |
(5.01 × 1 + 7.16 × 0.915 + 1.07 × 0.397) × $33.4009 = $400.35
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
27768 billing questions
How does this differ from 27767?
Use 27768 when closed treatment includes manipulation of the posterior malleolus fracture. Code 27767 is the corresponding closed-treatment option without manipulation.
When would 27769 be more appropriate?
27769 is for open treatment of a posterior malleolus fracture. This code describes closed treatment with manipulation, without surgically exposing the fracture.
Is related postoperative care included?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are other procedures in the same session paid?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
How is bilateral treatment handled?
When the procedure is performed bilaterally and reported with modifier 50, Medicare payment is 150%.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
3,04227762,,Cltx med ankle fx w/mnpj,A,,5.33,11.10,,8.15,,1.21,17.64,14.69,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,04327766,,Optx medial ankle fx,A,,7.69,8.18,NA,8.18,,1.49,17.36,17.36,0,090,0.10,0.69,0.21,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,04427767,,Cltx post ankle fx,A,,2.57,6.58,,5.95,,0.48,9.63,9.00,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,04527768,,Cltx post ankle fx w/mnpj,A,,5.01,7.16,NA,7.16,,1.07,13.24,13.24,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,04627769,,Optx post ankle fx,A,,9.89,8.37,NA,8.37,,1.97,20.23,20.23,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,04727780,,Treatment of fibula fracture,A,,2.76,7.26,,5.60,,0.56,10.58,8.92,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,04827781,,Treatment of fibula fracture,A,,4.48,9.28,,6.80,,0.93,14.69,12.21,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136