CPT 27514 Open ORIF Femoral Condyle Reimbursement | OpenPayer

Summary & Overview

CPT 27514: Open Reduction and Internal Fixation of Femoral Condyle Fracture

CPT code 27514 represents open reduction and internal fixation (ORIF) of femoral condyle fractures using pins, screws, or wires. This operative code captures definitive surgical management intended to realign and stabilize distal femoral articular fragments, a procedure that impacts perioperative resource use, post-acute care needs, and orthopedic quality measurement. Nationally, femoral condyle ORIF is clinically significant because it is associated with functional recovery, risk of posttraumatic arthritis, and variable utilization across hospital and ambulatory surgical settings.

Key payers considered in related analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and typical sites of service, plus benchmarking and reimbursement considerations where available. The publication outlines common modifiers and payer-related billing considerations, summarizes typical care pathways for this surgical service line, and highlights implications for coding accuracy and documentation. The material is intended to support revenue cycle teams, orthopedic clinicians, and policy analysts in understanding the code’s clinical scope, billing context, and its role in surgical quality and cost discussions at a national level. Data not available in the input is noted where relevant.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 27514orthopedic surgeryfemoral condyle fractureopen reduction internal fixationORIFsurgical codingambulatory surgical centerhospital inpatient

Billing Code Overview

CPT code 27514 describes an open reduction and internal fixation (ORIF) of femoral condyle fracture using pins, screws, or wires. The procedure aligns fractured femoral condylar fragments to restore normal anatomy and stability of the distal femur.

Service Type: Orthopedic surgical fracture repair (open reduction and internal fixation)

Typical Site of Service: Inpatient or outpatient hospital setting, or ambulatory surgical center, depending on fracture severity and patient condition.

Clinical & Coding Specifications

Clinical Context

A 42-year-old adult presents after a high-energy fall from a ladder with acute pain, swelling, and inability to bear weight on the affected knee. Radiographs and CT confirm a displaced fracture of the lateral femoral condyle with articular involvement. The orthopedic trauma surgeon schedules an open reduction and internal fixation to anatomically reduce the condylar fragment and stabilize the articular surface using screws and/or pins to restore joint congruity.

Preoperative workflow includes history and physical, review of imaging (X-ray, CT), informed consent, anesthesia evaluation (commonly general or regional blockade), and perioperative antibiotics. Intraoperative steps include surgical exposure of the distal femur, reduction of the fracture under direct visualization and fluoroscopic guidance, fixation using screws, pins, or wires as indicated, and assessment of articular alignment and stability. Postoperative care involves pain control, DVT prophylaxis, wound checks, radiographic confirmation of fixation, and an individualized rehabilitation plan with weight-bearing restrictions determined by fixation stability.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the work required is substantially greater than typical for open reduction and internal fixation of femoral condyles due to complexity (eg, extensive comminution, prolonged operative time).

CPT 27552: Closed Reduction of Knee Dislocation under Anesthesia

CPT-27538-CLOSED-REDUCTION-INTERCONDYLAR-SPINE-KNEE-FRACTURE

CPT 27538: Closed Reduction of Intercondylar Spine or Tuberosity Knee Fracture

27507-OPEN-TREATMENT-OF-FEMORAL-SHAFT-FRACTURE-WITH-PLATESCREWS

CPT 27507: Open Fixation of Femoral Shaft Fracture with Plate and Screws

CPT-27509-PERCUTANEOUS-FEMORAL-CONDYLAR-FRACTURE-FIXATION

CPT 27509: Percutaneous Fixation of Femoral Condylar Fracture

CPT-27520-CLOSED-REDUCTION-PATELLA-FRACTURE

CPT 27520: Closed Reduction of Patella Fracture

CPT-27516-DISTAL-FEMORAL-EPIPHYSEAL-SEPARATION-CLOSED-REDUCTION

CPT 27516: Closed Reduction of Distal Femoral Epiphyseal Separation

CPT-27513-DISTAL-FEMUR-INTERCONDYLAR-FRACTURE-OPEN-REDUCTION

CPT 27513: Open Reduction, Distal Femur Intercondylar Fracture

CPT-27519-DISTAL-FEMORAL-EPIPHYSEAL-SEPARATION-OPEN-REDUCTION-FIXATION

CPT 27519: Open Reduction of Distal Femoral Epiphyseal Separation

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

CPT 27558: ORIF of Dislocated Knee with Ligament Repair

CPT-27536-BICONDYLAR-PROXIMAL-TIBIAL-PLATEAU-FRACTURE-FIXATION

CPT 27536: Open Reduction and Internal Fixation of Bicondylar Proximal Tibial Plateau Fracture

Showing 1–10 of 30

Taxonomy Code	Specialty	Notes
208W00000X	Orthopaedic Surgery	Primary specialty performing fracture fixation of femoral condyles.
207L00000X	Sports Medicine	Often manages articular fractures in active patients and provides perioperative care and rehabilitation.
208000000X	General Surgery (Trauma/Orthopedics overlap)	Trauma surgeons with orthopaedic subspecialty focus may perform complex distal femur fracture fixation.
207K00000X	Hand Surgery	Data not applicable; include only core orthopaedic specialties.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S72.45`	Fracture of lateral condyle of femur	Directly describes a lateral femoral condyle fracture often treated with ORIF using screws/pins.
`S72.46`	Fracture of medial condyle of femur	Medial condyle fractures may require the same `27514` fixation technique when specified.
`S72.40`	Unspecified fracture of distal femur	Used when more specific condylar detail is not available; still clinically relevant for surgical fixation.
`S72.451`	Displaced fracture of lateral condyle of right femur	Specifies displacement and laterality guiding operative management and coding with `RT`.
`S72.452`	Displaced fracture of lateral condyle of left femur	Specifies displacement and laterality guiding operative management and coding with `LT`.
`S72.441`	Displaced fracture of medial condyle of right femur	Specifies displaced medial condyle fracture for operative planning.
`S72.442`	Displaced fracture of medial condyle of left femur	Specifies displaced medial condyle fracture for operative planning.
`M25.561`	Pain in right knee	Common presenting symptom and supportive secondary diagnosis during pre- and postoperative visits.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27514`	Open treatment of distal femoral fracture, condyles, with internal fixation by pins, screws or wires	Primary procedure for fixation of femoral condyle fractures.
`20680`	Removal of implant; deep (eg, buried wires, pins)	May be required later to remove buried hardware such as pins or wires placed during `27514`.
`73564`	Radiologic examination, knee, bilateral; 3 views	Preoperative or postoperative radiographs to assess fracture alignment and hardware position; adjunct imaging in workflow.
`73565`	Radiologic examination, knee, unilateral; 3 views	Standard imaging for the injured knee pre- and postoperatively.
`29880`	Arthroscopy, knee, surgical; with meniscal repair	Performed in conjunction if there is intra-articular pathology identified and treated during the same anesthetic (rare; if performed, bill separately as appropriate).
`27495`	Osteotomy, femur, distal; segmental, with internal fixation	Occasionally performed in complex reconstruction cases where realignment is required in addition to condylar fixation; reported separately when clinically performed.

OpenPayer