Summary & Overview

CPT 27244: Open Femoral Fracture Fixation with Plate and Screws

CPT code 27244 covers open surgical treatment of femoral shaft and subtrochanteric fractures using plate and screw fixation, often with cerclage to secure fragments. This code captures a common orthopedic surgical approach for stabilizing fractures between, around, or below the trochanters and is clinically important for restoring limb alignment, enabling early mobilization, and preventing complications. Nationally, management of femoral fractures involves hospitals and ambulatory surgery centers and has implications for surgical resource use, implant costs, and post-acute care needs.

Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical context and typical settings of service, plus benchmarking and policy-relevant content where available. The publication addresses coding boundaries for open plate-and-screw fixation, common modifiers used in claims, and considerations relevant to coverage determinations and claim adjudication. Where input data is incomplete, the publication notes that specific elements are not available. The material is intended for revenue cycle professionals, orthopedic clinicians, and policy analysts who need a national perspective on billing, clinical use, and payer considerations for CPT code 27244.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare27244CPTorthopedicsfemoral fractureopen fixationplate and screwscerclagesurgical billingoperating room

Billing Code Overview

CPT code 27244 describes an open treatment of a femoral fracture at or below the trochanters using plate and screw fixation. The procedure includes placement of a plate with screws to stabilize the fractured femur and may include cerclage (a metal band or wire loop wrapped around fracture fragments) to help secure bone fragments.

Service type: Orthopedic open fracture fixation with internal fixation (plate and screws), may include adjunctive cerclage.

Typical site of service: Inpatient or outpatient hospital operating room, or ambulatory surgery center, depending on patient condition and facility capability.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult who sustains a displaced fracture of the femoral shaft or subtrochanteric region after a fall from standing, a motor vehicle collision, or a high-energy mechanism. The patient presents to the emergency department with acute thigh pain, deformity, swelling, and inability to bear weight. Initial evaluation includes focused trauma assessment, AP and lateral radiographs of the femur and hip, and CT if needed for complex patterns.

The clinical workflow: the patient is admitted, given analgesia and, if indicated, thromboembolism prophylaxis and tetanus update. Preoperative planning includes review of imaging, determination that open reduction and internal fixation (ORIF) with plate and screws (and optional cerclage wiring) is the optimal fixation strategy (for fractures between, around, or below the trochanters). Informed consent is obtained. The procedure is performed in an operating room under general or regional anesthesia. Intraoperative steps include exposure of the fracture, debridement of soft tissues as needed, reduction of the fragments, temporary fixation (clamps, Kirschner wires), application of an anatomic or locking plate with screws to stabilize the femur, and optional cerclage wiring for fragment control. Fluoroscopy is used to confirm reduction and hardware position. Postoperative care includes pain control, neurovascular checks, weight-bearing status per fixation stability, outpatient or inpatient physical therapy, and follow-up radiographs to monitor healing.

Typical site of service: Hospital inpatient or Hospital outpatient/ambulatory surgery center depending on patient stability and comorbidities.

Service type: Open surgical fracture fixation (ORIF) of proximal/mid/distal femur with plate and screws, possibly including cerclage wiring.

Common patient scenario: a 68-year-old with osteoporosis who slips at home and sustains a subtrochanteric femoral fracture requiring open reduction and internal fixation with a locking plate and supplemental cerclage wires. The procedure is billed with 27244 and performed under general anesthesia with intraoperative fluoroscopy in the OR; the patient is admitted for pain control and early mobilization.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the work, time, or intensity substantially exceeds typical for `27244` (documentation must justify).
`23`	Unusual anesthesia	Use if medically necessary anesthesia beyond expected for this procedure is provided under local/state rules.
`50`	Bilateral procedure	Use if bilateral femoral ORIF with plates is performed (rare for femur; use only if both sides treated same day).
`51`	Multiple procedures	Use when `27244` is reported with other distinct surgical procedures during the same operative session.
`52`	Reduced services	Use if the service was partially reduced or not completed as planned.
`53`	Discontinued procedure	Use if the procedure was started but terminated due to extenuating circumstances.
`62`	Two surgeons	Use when two surgeons with different NPI numbers perform distinct surgical components intraoperatively.
`63`	Procedure performed on infants less than 4 kg	Use when applicable per CMS guidance (rare for femoral fracture in this weight group).
`66`	Surgical team approach	Use when a surgical team approach is documented for complex fracture management.
`78`	Return to OR for related procedure following initial surgery	Use when a patient returns to the OR for a related procedure during the global period.
`79`	Unrelated procedure or service by the same physician during the post-op period	Use when an unrelated procedure is performed during the global period.
`80`	Assistant surgeon	Use when an assistant surgeon provides assistance (general assistant surgeon role).
`81`	Minimum assistant surgeon	Use when a minimal assistant surgeon role is documented.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist as assistant at surgery	Use when an advanced practice clinician assists and payor allows this modifier.

Taxonomy Code	Specialty	Notes
`208800000X`	Orthopedic Surgery	Primary specialty performing femoral ORIF and plate/screw fixation.
`2086S0200X`	Orthopedic Trauma	Subspecialty focused on complex fractures and perioperative trauma care.
`207L00000X`	Sports Medicine (Orthopedics)	May perform fixation of select femoral fractures in certain centers.
`163W00000X`	Surgical Critical Care	Provides perioperative and critical care management for multisystem trauma patients.
`341600000X`	Physical Medicine & Rehabilitation	Manages postoperative mobilization and rehabilitation planning.

CPT Code	Description	Relationship to This Procedure
`20680`	Removal of implant; deep (e.g., buried plates, screws)	May be performed later if hardware causes symptoms or after fracture union necessitates implant removal.
`11010`	Debridement of complex wound, includes removal of foreign material	May be used if open fracture with contaminated wound requires formal debridement at time of ORIF.
`76000`	Fluoroscopy (separate procedural code for imaging)	Intraoperative fluoroscopic guidance used to confirm reduction and hardware placement; often reported by the facility/technical component.
`27130`	Open treatment of femoral neck fracture, includes internal fixation	Alternative fixation code for femoral neck fractures; selected when fracture location and treatment differ from trochanteric/subtrochanteric ORIF.
`27245`	Open treatment of femoral fracture, proximal end, with intramedullary implant	Related fixation method; used when intramedullary nailing is chosen instead of plating.
`99324`	Initial hospital inpatient care, short stay (examples for global period billing)	Used to report initial inpatient evaluation and management associated with the surgical admission when separate from global surgical package.

OpenPayer