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CPT 27506: Open Reduction of Femoral Shaft Fracture with Intramedullary Fixation
CPT code 27506 denotes an open reduction of femoral shaft fracture with intramedullary fixation, a definitive surgical treatment to realign and stabilize femoral shaft fractures. This procedure is a high-acuity orthopaedic operation with implications for surgical resource use, facility planning, and national episode cost given its role in trauma and fracture care.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise clinical context for the procedure, guidance on typical sites of service and service type, common related diagnosis groupings, and comparisons to related procedures such as plate-and-screw fixation. The publication summarizes how the code is positioned in billing workflows, common modifier usage (listed separately), and relevant ICD-10 diagnoses tied to femoral fractures and implant-related complications.
The content provides benchmarks and policy-relevant information for revenue cycle managers, orthopaedic surgeons, and hospital administrators seeking to align coding, clinical documentation, and payer expectations for femoral shaft fracture operative care. Data not available in the input will be noted explicitly in designated sections of the full publication.
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Billing Code Overview
CPT code 27506 describes an open reduction of femoral shaft fracture with intramedullary fixation, performed with or without external fixation. The procedure restores alignment of the femoral shaft and secures the bone with an intramedullary device to promote stable healing.
Service type: Surgical — Orthopaedic fracture fixation
Typical site of service: Inpatient hospital or outpatient hospital surgical facility / ambulatory surgery center, depending on patient condition and surgical setting.
National Reimbursement Benchmarks
Medicare’s national mean for CPT 27506 sits at $1,242.60, while BUCA’s mean for commercial contracts is substantially higher at $2,667.90, indicating a roughly $1,425.30 gap between public and that commercial benchmark. This differential highlights that commercially negotiated averages with BUCA are a material premium over Medicare rates, with Medicare’s median locality value centered near $1,221 and BUCA’s median at $1,921.80.
Dispersion (P75 minus P25) varies notably by payer: Blue Cross Blue Shield’s spread is $2,749.10 (P75 $4,233.00 minus P25 $1,483.90), the widest among listed payers, while Aetna’s spread is $1,164.20 (P75 $1,406.40 minus P25 $240.20), the tightest. UnitedHealth Group, Cigna, and BUCA show intermediate dispersion of $1,451.30, $1,507.70, and $2,160.20 respectively, reflecting diverse contracting dynamics across commercial payers.