CPT 27232: Closed Treatment of Femoral Neck Fracture

CPT code 27232 denotes the closed treatment (closed reduction) of a femoral neck fracture, an important orthopedic procedure for managing fractures at the upper end of the femur. Nationally, this code represents a frequently needed acute intervention for older adults and trauma patients where nonopen techniques — including manipulation and optional skeletal traction — are used to realign the fracture without open surgical exposure. Use of this code affects hospital and surgical billing, care pathways in emergency and perioperative settings, and payer coverage decisions for fracture management.

Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for closed femoral neck fracture management, typical sites of service, and the billing implications tied to this procedure. The publication outlines benchmarks and payment context where available, summarizes relevant policy considerations affecting authorization and site-of-service determination, and highlights operational considerations for coding and billing teams responsible for orthopedic trauma cases.

This summary is intended for national audiences including coding professionals, revenue cycle staff, orthopedic clinicians, and payer policy analysts seeking a clear, clinically grounded view of CPT code 27232 and its role in acute fracture care.

Billing Code Overview

CPT code 27232 describes a closed treatment of a femoral neck fracture, a fracture of the upper end of the femur. The procedure includes manipulation (adjustment) of the fractured bone and may incorporate skeletal traction as part of the closed reduction technique.

Service Type: Fracture management / Orthopedic closed reduction

Typical Site of Service: Hospital inpatient or outpatient operating room, emergency department, or ambulatory surgical center depending on clinical severity and facility capabilities

Clinical Context

A typical patient is an older adult who presents to the emergency department after a fall at home with acute left hip pain, inability to bear weight, and externally rotated, shortened lower extremity. Radiographs confirm a displaced femoral neck fracture. The orthopedic surgeon performs a closed reduction under procedural sedation or general anesthesia in the operating room or emergency department, manipulating the proximal femur to realign the fracture and often applying percutaneous fixation (e.g., pins or screws) or temporary skeletal traction as clinically indicated. Pre-procedure workflow includes trauma evaluation, neurovascular exam, analgesia and immobilization, informed consent, and anesthesia assessment. Post-procedure care includes repeat imaging to confirm reduction, pain control, DVT prophylaxis, physical therapy planning, and discharge or admission to an inpatient orthopedic service depending on stability and comorbidities.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when documentation supports substantially greater work, time, or intensity than usual for closed treatment of femoral neck fracture.
`23`	Unusual anesthesia

Taxonomy Code	Specialty	Notes
207X00000X	Orthopedic Surgery	Primary specialty performing closed reduction and fixation of femoral neck fractures.
208000000X	General Surgery	May be involved in trauma settings when orthopedics not immediately available.
208100000X	Trauma Surgery	Manages acute polytrauma including femoral neck fractures in the trauma bay.
363A00000X	Emergency Medicine	Performs initial stabilization, sedation, and occasionally closed reduction in the ED prior to definitive care.
207L00000X	Hand Surgery (proxy for surgical subspecialty)	Data not available in the input.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S72.001A`	Fracture of unspecified part of neck of right femur, initial encounter for closed fracture	Typical diagnosis for a closed femoral neck fracture treated with closed reduction.
`S72.002A`	Fracture of unspecified part of neck of left femur, initial encounter for closed fracture	Same as above for the left side.
`S72.011A`	Fracture of right femoral neck, displaced, initial encounter for closed fracture	Displaced neck fractures often require reduction and fixation; directly relevant to this CPT.
`S72.012A`	Fracture of left femoral neck, displaced, initial encounter for closed fracture	Left-sided counterpart for displaced fractures.
`S72.091A`	Other fracture of right femoral neck, initial encounter for closed fracture	Covers atypical or unspecified neck fracture patterns managed with closed techniques.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27230`	Closed treatment of femoral shaft fracture; without manipulation	Performed for femoral shaft fractures; may be considered when fracture level differs from femoral neck and helps distinguish coding for proximal femur injuries.
`27235`	Open treatment of femoral neck fracture, includes internal fixation or prosthetic replacement	Represents the open surgical alternative when closed reduction is not successful or fracture pattern requires open fixation or arthroplasty.
`20690`	Application of traction device (e.g., skeletal traction)	Codes ancillary application of traction devices that may be used as part of closed management for stabilization prior to definitive fixation.
`73502`	Radiologic examination, hip, unilateral; 2 views	Common pre- and post-procedure imaging to confirm fracture and reduction.
`99152`	Moderate sedation services (initial 15 minutes)	Used when procedural sedation is provided for closed reduction outside of general anesthesia.

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Summary & Overview