CPT 27511 Supracondylar Femur ORIF Reimbursement | OpenPayer

Summary & Overview

CPT 27511: Supracondylar Femur Fracture Open Reduction with Fixation

CPT code 27511 represents an open reduction and internal fixation (ORIF) procedure for supracondylar fractures of the femur that do not involve the intercondylar region. This code captures a common orthopedic surgical approach to realign and stabilize distal femur fractures using screws, pins, or wires. Nationally, accurate coding for fracture fixation is important for surgical quality reporting, resource planning, and appropriate payment for operative musculoskeletal care.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, common billing considerations, and an overview of what to expect in payer coverage patterns and billing benchmarks where available. The publication outlines common modifiers used with this procedure and highlights areas where coding specificity matters for correct claim processing.

The report is designed for billing managers, orthopedic surgeons, and policy analysts seeking a clear reference for CPT code 27511, including clinical intent of the code, procedural setting, and the practical billing metadata necessary for claims and administrative workflows. Data not available in the input is noted where relevant.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 27511orthopedic surgeryfemur fractureopen reduction internal fixationsurgical billingambulatory surgeryhospital services

Billing Code Overview

CPT code 27511 describes an open reduction and internal fixation procedure for a supracondylar femur fracture that does not extend into the intercondylar region. The procedure involves surgically exposing the fracture and using screws, pins, or wires to realign and stabilize the distal femur to promote proper healing.

Service type: Surgical orthopedic procedure — open reduction with internal fixation
Typical site of service: Hospital operating room or ambulatory surgery center

Clinical & Coding Specifications

Clinical Context

A 42-year-old male presents to the emergency department after a high-energy fall from a ladder with severe left distal femur pain, swelling, and deformity above the knee. Radiographs and CT confirm a supracondylar femur fracture that does not extend into the intercondylar region. The orthopedic trauma team evaluates the patient, obtains informed consent, and schedules urgent operative management. Preoperative workup includes neurovascular exam, templated imaging, and medical clearance. In the operating room under general anesthesia, the surgeon performs an open reduction of the supracondylar distal femur fracture and stabilizes the bone fragments using screws and percutaneous pins as needed, ensuring anatomic alignment and stable fixation. Postoperative care includes pain control, deep venous thrombosis prophylaxis, repeat radiographs, and physical therapy planning with weight-bearing status specified. Typical site of service is inpatient hospital operating room or ambulatory surgical center for non-multi-system trauma, depending on patient condition and comorbidities. The service type is surgical fracture repair (open reduction and internal fixation) of the distal femur (supracondylar region).

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the surgeon’s professional component separate from hospital/ASC facility charges.

CPT 27500: Femoral Shaft Fracture Reduction

CPT-27556-OPEN-REDUCTION-INTERNAL-FIXATION-DISLOCATED-KNEE

CPT 27556: Open Reduction and Internal Fixation of Dislocated Knee

CPT-27540-KNEE-INTERCONDYLAR-SPINE-TUBEROSITY-ORIF

CPT 27540: ORIF of Intercondylar Spine or Tuberosity of Knee

CPT-27510-CLOSED-REDUCTION-DISTAL-FEMUR-CONDYLAR-FRACTURE

CPT 27510: Closed Reduction of Distal Femur Condylar Fracture

CPT-27558-OPEN-REDUCTION-INTERNAL-FIXATION-KNEE-LIGAMENT-REPAIR

CPT 27558: ORIF of Dislocated Knee with Ligament Repair

CPT-27562-CLOSED-REDUCTION-PATELLA

CPT 27562: Closed Reduction of Dislocated Patella

CPT-27503-CLOSED-REDUCTION-SUPRACONDYLAR-FEMUR-FRACTURE

CPT 27503: Closed Reduction of Supracondylar Femur Fracture

CPT-27566-OPEN-REDUCTION-PATELLA-PATELLECTOMY

CPT 27566: Open Reduction of Dislocated Patella, ± Patellectomy

CPT-27532-CLOSED-REDUCTION-BICONDYLAR-PROXIMAL-TIBIAL-PLATEAU-FRACTURE-TRACTION

CPT 27532: Closed Reduction, Bicondylar Proximal Tibial Plateau Fracture

27506-OPEN-TREATMENT-OF-FEMORAL-SHAFT-FRACTURE-WITH-OR-WITHOUT

CPT 27506: Open Intramedullary Fixation of Femoral Shaft Fracture

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Taxonomy Code	Specialty	Notes
207L00000X	Orthopaedic Surgery	Primary specialty performing open reduction and internal fixation of femoral fractures.
2080P0206X	Orthopedic Trauma Surgery	Subspecialty focus on complex fractures and perioperative trauma care.
207R00000X	Surgery: General	General surgeons occasionally involved in polytrauma settings or when orthopedic coverage unavailable.
208000000X	Emergency Medicine	Initial diagnosis and stabilization in the ED prior to definitive operative care.
261QM0800X	Anesthesiology	Provides general or regional anesthesia for operative fixation procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S72.441A`	Displaced supracondylar fracture of left femur, initial encounter for closed fracture	Typical presenting diagnosis for left supracondylar femur fracture treated with open reduction and internal fixation.
`S72.442A`	Displaced supracondylar fracture of right femur, initial encounter for closed fracture	Typical presenting diagnosis for right supracondylar femur fracture treated with open reduction and internal fixation.
`S72.451A`	Unspecified supracondylar fracture of left femur, initial encounter for closed fracture	Used when displacement is not specified but surgical fixation is performed.
`S72.452A`	Unspecified supracondylar fracture of right femur, initial encounter for closed fracture	As above for the right side.
`S72.431A`	Distal femoral fracture involving medial condyle, left, initial encounter for closed fracture	Included when fracture approaches but does not extend into intercondylar area or condylar involvement suspected.
`S72.430A`	Distal femoral fracture involving unspecified condyle, initial encounter for closed fracture	Used for distal femoral fractures near the supracondylar region when laterality or specific condyle not specified.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27511`	Open treatment of supracondylar fracture of femur; with internal fixation using screws, pins, or wires (fracture does not extend into intercondylar area)	Primary procedure for open reduction and internal fixation of supracondylar distal femur fractures.
`27447`	Arthroplasty, knee, condyle and plateau; medial OR lateral compartment	May be relevant for older patients with severe articular involvement where fixation is not appropriate; alternative reconstruction.
`27520`	Open treatment of distal femoral fracture, with or without internal or external fixation, proximal to the condyles	Used for more proximal distal femoral fractures or when fracture pattern extends beyond supracondylar region.
`20690`	Aspiration and/or injection of joint or bursa; without ultrasound guidance	Sometimes performed postoperatively for joint effusion management; ancillary service in postoperative course.
`20680`	Removal of implanted hardware, deep (requiring incision and dissection)	May be performed at a later date if hardware removal is indicated after fracture healing.
`73630`	Radiologic examination, lower extremity, femur; 1 view	Preoperative and postoperative radiographs are performed to document fracture and fixation alignment.

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