CPT 27448: Femoral Osteotomy to Correct Alignment - OpenPayer

Summary & Overview

CPT 27448: Femoral Osteotomy to Correct Alignment

CPT code 27448 represents a femoral osteotomy procedure that involves cutting a portion of the femur’s shaft or supracondylar area to correct alignment and deformity without implantation of fixation hardware. This surgical intervention is important for restoring limb alignment, improving joint mechanics, and relieving deformity-related symptoms. Nationally, femoral osteotomies are performed across pediatric and adult orthopedic populations for indications such as malunion, deformity correction, and joint preservation strategies, making accurate coding and coverage understanding essential for hospitals and surgical centers.

Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise national overview of coverage and common billing practices, and highlights the clinical context in which this code is used. Readers will find benchmarks for utilization and reimbursement trends where available, summaries of payer coverage behavior, and clinical considerations relevant to coding and site-of-service decisions. The report also outlines common modifiers and coding nuances associated with surgical osteotomies, and points readers to where more detailed policy language and local payer rules can be found. Data not available in the input is noted explicitly where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare27448CPTfemoral osteotomyorthopedic surgerybone osteotomyambulatory surgical centerinpatient surgeryprocedure coding

Billing Code Overview

CPT code 27448 describes an osteotomy of the femur in which a portion of bone is cut from the shaft or supracondylar area of the thigh to correct alignment and deformity without the use of fixation devices. This procedure is a corrective bone surgery aimed at restoring proper limb alignment and joint mechanics.

Service type: Surgical corrective osteotomy of the femur
Typical site of service: Hospital inpatient or outpatient surgical facility, or ambulatory surgical center, depending on clinical complexity and post‑operative needs

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 45-year-old female presents with progressive varus deformity of the distal femur causing lateral knee compartment overload and pain despite conservative management. Imaging demonstrates a supracondylar femoral malalignment with mechanical axis deviation and early unicompartmental joint degeneration. The orthopedic surgeon schedules an open distal femoral osteotomy (shaft/supracondylar femur) without internal fixation to correct coronal plane alignment. The patient undergoes preoperative clearance, informed consent, and preoperative templating. In the operating room under general or regional anesthesia, the surgeon makes an open approach to the distal femur, performs a controlled osteotomy through the shaft/supracondylar region, removes a wedge or segment of bone as planned, and achieves realignment. No internal fixation devices are implanted during the procedure. Postoperative workflow includes neurovascular check, immobilization (cast or brace) as indicated, pain control, DVT prophylaxis, physical therapy initiation, and clinic follow-up with serial radiographs to document alignment and healing. Typical site of service is an outpatient or inpatient surgical suite at a hospital or ambulatory surgery center depending on patient comorbidities and anesthesia needs.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work or time substantially exceeds typical for the osteotomy (document reasons).

CPT 27466: Femur Lengthening by Osteodistraction

cpt-27458-femoral-lengthening-with-internal-device

CPT 27458: Femoral Osteotomy with Intramedullary Lengthening Device

cpt-27454-femoral-osteotomy-intramedullary-rod-fixation

CPT 27454: Multiple Femoral Osteotomies with Intramedullary Rod Fixation

cpt-27430-quadriceps-release-knee-flexion-improvement

CPT 27430: Quadriceps Femoris Release to Improve Knee Flexion

cpt-27435-knee-posterior-capsulotomy-flexion-contracture-release

CPT 27435: Knee Posterior Capsulotomy for Flexion Contracture

cpt-27496-thigh-knee-fasciotomy-compartment-decompression

CPT 27496: Fasciotomy of Thigh/Knee to Relieve Compartment Pressure

cpt-27438-patellar-prosthesis-replacement

CPT 27438: Patellar Prosthesis Replacement

cpt-27465-femoral-shortening-surgery-leg-length-discrepancy

CPT 27465: Femoral Shortening Surgery for Leg Length Discrepancy

cpt-27443-knee-femoral-condyle-tibial-plateau-reconstruction-synovectomy

CPT 27443: Knee Reconstruction with Partial Synovectomy and Debridement

cpt-27420-patellar-tendon-transfer-bone-block

CPT 27420: Patellar Tendon Transfer with Bone Block

Showing 1–10 of 59

Taxonomy Code	Specialty	Notes
`2080P0208X`	Orthopedic Surgery	Adult reconstruction and deformity correction of the femur and knee.
`2080S0122X`	Pediatric Orthopedics	When osteotomy is performed for pediatric femoral deformity correction.
`207L00000X`	Orthopedic Hand (not typical)	Data not typical for this procedure; included only as a general orthopedics taxonomy.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M20.06`	Valgus deformity, acquired, right lower leg	Valgus malalignment of the distal femur/knee that may be corrected by distal femoral osteotomy.
`M20.16`	Valgus deformity, acquired, left lower leg	Same as above for the left side; laterality guides `LT`/`RT` modifiers.
`M21.26`	Malalignment of limb, acquired, right lower limb	General code for acquired limb malalignment involving the femur shaft/supracondylar area requiring osteotomy.
`M21.36`	Malalignment of limb, acquired, left lower limb	Same as above for the left side.
`M17.0`	Bilateral primary osteoarthritis of knee	Arthritis from malalignment often drives corrective osteotomy to offload an affected compartment.
`S82.101A`	Unspecified fracture of shaft of right tibia, initial encounter for closed fracture	Included only when prior fracture to the lower limb produced femoral malunion necessitating osteotomy for correction.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27448`	Osteotomy, femur, shaft or supracondylar area, corrective; without fixation	Primary procedure — distal femoral osteotomy performed to correct alignment without fixation.
`27075`	Osteotomy, femur, proximal, intertrochanteric or subtrochanteric, single or multiple; open	May be performed when deformity originates more proximally and proximal correction is required in the same episode of care.
`27446`	Osteotomy, femur, shaft or supracondylar area, corrective; with fixation	Used when internal fixation (plates, screws) is implanted instead of performing without fixation — alternative technique.
`27486`	Osteotomy, femoral condyle, single or multiple, with or without internal fixation	Performed when correction focuses on the femoral condyle rather than shaft or supracondylar region; may be adjunctive.
`20690`	Application of external fixation system	Used when temporary external fixation is applied intraoperatively or postoperatively to maintain alignment in lieu of internal fixation.
`73560`	Radiologic examination, knee; 2 views	Common intraoperative and postoperative imaging for alignment assessment and follow-up radiographs.

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