No office rate
Use 27538 for closed treatment without manipulation of the tibial spine or tuberosity fracture. Code 27540 describes open treatment of that fracture pattern.
On this page
CMS RVU26D · Effective 2026-10-01
27538 Knee fracture care Medicare reimbursement rates in Massachusetts
Reports closed treatment without manipulation of a knee fracture involving the tibial intercondylar spine or tibial tuberosity. Compare 27538 office and facility rates across CMS payment localities in Massachusetts.
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 27538 in Massachusetts?
Massachusetts has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$552.12–$607.16
2 of 2 localities have a supported rate.
Facility setting
$459.27–$501.88
2 of 2 localities have a supported rate.
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 27538: Closed treatment of tibial spine or tubercle fracture
Reports closed treatment without manipulation of a knee fracture involving the tibial intercondylar spine or tibial tuberosity.
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.
CMS billing rules for 27538
- 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
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU4.96 · 31%
- Practice expense (office) RVU10.11 · 63%
- Malpractice RVU1.06 · 7%
131
Medicare services in 2024 · #4658 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.
27538 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
$359.82–$398.19
Code 27530 is for closed treatment without manipulation of a tibial plateau fracture, not a tibial spine or tuberosity fracture.
$692.77–$757.53
Code 27532 addresses a tibial plateau fracture treated closed with manipulation. Code 27538 concerns a different fracture site and treatment without manipulation.
$380.47–$420.16
Code 27520 is for closed treatment of a patellar fracture without manipulation. Code 27538 applies to the tibial spine or tuberosity.
Compare 27538 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.
2 of 2 payment localities
Metropolitan Boston →
Office / nonfacility
$607.16
Facility
$501.88
Rest Of Massachusetts →
Office / nonfacility
$552.12
Facility
$459.27
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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 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.
2,94027532,,Treat knee fracture,A,,7.36,11.43,,7.74,,1.54,20.33,16.64,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,94127535,,Treat knee fracture,A,,13.07,8.59,NA,8.59,,2.75,24.41,24.41,0,090,0.10,0.69,0.21,2,1,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,94227536,,Treat knee fracture,A,,16.96,12.10,NA,12.10,,3.60,32.66,32.66,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,94327538,,Treat knee fracture(s),A,,4.96,10.11,,7.47,,1.06,16.13,13.49,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,94427540,,Treat knee fracture,A,,11.02,9.48,NA,9.48,,2.33,22.83,22.83,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,94527550,,Treat knee dislocation,A,,5.83,11.35,,8.50,,1.33,18.51,15.66,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,94627552,,Treat knee dislocation,A,,7.98,8.49,NA,8.49,,1.68,18.15,18.15,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00