CPT 27358 Internal Fixation Reimbursement | OpenPayer

Summary & Overview

CPT 27358: Orthopedic Internal Fixation Add-On Procedure

CPT code 27358 identifies an add-on orthopedic surgical procedure in which internal fixation devices (for example, screws or plates) are applied to provide additional stability. As an add-on code, 27358 is reported in conjunction with a separate primary procedure and signals the use of implant-based stabilization techniques that can alter procedural complexity, operative time, and payment bundling. Nationally, accurate reporting of this code affects surgical claims processing, facility and professional fee reconciliation, and aggregated utilization metrics for orthopedic trauma and reconstructive services.

Key payers in this review include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of clinical intent, typical sites of service, and the role of 27358 as an adjunct to primary procedures. The publication provides benchmarks where available, summarizes common payer considerations, and outlines the clinical context for when internal fixation add-ons are used. Data limitations are noted when source information is not present. The content is intended for billing managers, coding professionals, and policy analysts seeking a national, payer-agnostic overview of CPT code 27358 and its implications for surgical billing and claims review.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare27358CPTorthopedic surgeryinternal fixationadd-on proceduresurgical codingoperating roomambulatory surgery

Billing Code Overview

CPT code 27358 is an add-on surgical procedure in which the provider applies internal fixation devices, such as screws or plates, to provide additional stability. The procedure augments primary surgical treatment by securing bony structures or repaired tissues to enhance mechanical stability.

Service Type

Surgical — Orthopedic add-on procedure

Typical Site of Service

Inpatient hospital operating room
Outpatient ambulatory surgery center

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 42-year-old male presents after a high-energy ankle fracture with instability of the distal tibia and fibula. Imaging demonstrates a displaced malleolar fracture with syndesmotic disruption. The orthopedic surgeon plans operative fixation under general or regional anesthesia. During the procedure, after fracture reduction, the provider applies internal fixation devices (plates and screws) to stabilize the fracture and restore joint alignment. 27358 is an add-on code describing the application of internal fixation devices to provide additional stability; it is reported in conjunction with the primary fracture fixation procedure when supplemental hardware is applied.

Typical clinical workflow:

Preoperative evaluation, imaging review, informed consent, and anesthesia assessment.
Operative fixation of the fracture (primary procedure documented with the appropriate primary CPT code for open reduction and internal fixation of the specific bone/joint).
Application of internal fixation devices (plates, screws, or supplemental hardware) noted in the operative report with details on device type, number, and anatomical location — billed using 27358 as the add-on when applicable.
Postoperative recovery, immobilization or protocol for weight-bearing, postoperative imaging to confirm alignment, and follow-up visits for wound check and hardware assessment.

Coding Specifications

CPT 27357: Femoral Bone Cyst Excision with Autograft

CPT-27333-KNEE-PARTIAL-MENISCECTOMY-MEDIAL-AND-LATERAL

CPT 27333: Knee Partial Meniscectomy, Medial and Lateral

CPT-27337-EXCISION-SUBCUTANEOUS-TUMOR-THIGH-KNEE-3CM-OR-LARGER

CPT 27337: Excision of Subcutaneous Tumor of Thigh or Knee, ≥3 cm

CPT-27340-PREPATELLAR-BURSA-EXCISION

CPT 27340: Excision of Prepatellar Bursa

CPT-27335-KNEE-ARTHROTOMY-ANTERIOR-POSTERIOR-SYNOVECTOMY-POPLITEAL

CPT 27335: Knee Arthrotomy with Anterior and Posterior Synovectomy

CPT-27356-FEMORAL-TUMOR-CYST-EXCISION-WITH-ALLOGRAFT-RECONSTRUCTION

CPT 27356: Femoral Tumor or Cyst Excision with Allograft Reconstruction

CPT-27355-FEMORAL-BENIGN-TUMOR-CYST-EXCISION

CPT 27355: Excision of Benign Femoral Tumor or Cyst

CPT-27365-FEMUR-KNEE-TUMOR-EXCISION

CPT 27365: Excision of Tumor, Femur or Knee

CPT-27334-KNEE-ARTHROTOMY-SYNOVECTOMY

CPT 27334: Knee Arthrotomy with Anterior or Posterior Synovectomy

CPT-27364-EXTENSIVE-EXCISION-SOFT-TISSUE-TUMOR-THIGH-KNEE-5CM-PLUS

CPT 27364: Extensive Excision of Soft Tissue Tumor, Thigh or Knee ≥5 cm

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Taxonomy Code	Specialty	Notes
207L00000X	Orthopedic Surgery	Primary specialty performing open reduction and internal fixation procedures.
207P00000X	Podiatric Medicine & Surgery	Performs internal fixation for foot and ankle fractures and related procedures.
2080P0252X	General Surgery (Trauma/Acute Care)	Trauma or acute care surgeons who perform fracture fixation in complex trauma cases.
207K00000X	Hand Surgery (Orthopedic)	For internal fixation of hand/wrist fractures when `27358` is used as applicable.
207XS0103X	Sports Medicine (Orthopedic)	Fixation procedures related to athletic injuries requiring supplemental hardware.

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`25607`	Open treatment of distal radius extra-articular fracture or epiphyseal fracture, with internal fixation	Primary open reduction and internal fixation code for distal radius fractures; `27358` may be billed as add-on when additional internal fixation devices are applied for stability.
`27766`	Open treatment of pilon or distal tibial fracture, internal fixation, includes internal fixation when performed	Primary open reduction and internal fixation of distal tibia fractures; `27358` is an add-on for supplemental fixation devices applied to improve stability.
`27814`	Open treatment of bimalleolar ankle fracture, with or without internal fixation	Primary ankle fracture fixation; `27358` may accompany when extra plates/screws are added for additional stability.
`28820`	Open treatment, metatarsal fracture, includes internal fixation, when performed	Primary metatarsal fixation; `27358` used as add-on for supplemental internal fixation devices.
`20690`	Application of a long-arm cast; should not be reported with certain fixation codes	Ancillary post-procedure immobilization commonly used after internal fixation; listed to show typical sequential care (not billed as add-on hardware).
`99024`	Postoperative follow-up visit global period (professional courtesy)	Routine postoperative follow-up during the global period after surgical fixation procedures.

`50`	Bilateral procedure	When identical internal fixation is performed on both sides during the same operative session (if applicable to paired structures).
`62`	Two surgeons	When two surgeons from different specialties work together and each performs distinct portions of the procedure.
`66`	Surgical team	When the service is performed under a documented surgical team approach (multiple surgeons with shared responsibility).
`78`	Unplanned return to OR within global period	When the patient returns to the operating room for a related procedure during the global period.
`79`	Unrelated procedure or service by the same physician during the postoperative period	When an unrelated procedure is performed during the global period (not commonly used for add-on fixation but included if relevant).
`22`	Increased procedural services	When work required is substantially greater than typical and appropriately documented.
`52`	Reduced services	When the service provided is partially reduced or not completed; document reason.
`53`	Discontinued procedure	When the procedure is started but discontinued due to extenuating circumstances or patient safety.
`63`	Procedures performed on infants less than 4 kg	If the patient is an infant meeting weight criteria and this add-on fixation is applied.
`76`	Repeat procedure by same physician	When the same physician repeats the procedure later the same day.
`77`	Repeat procedure by different physician	When a different physician repeats the procedure later the same day.

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