Summary & Overview
CPT 27516: Closed Reduction of Distal Femoral Epiphyseal Separation
CPT code 27516 designates a closed reduction procedure for distal femoral epiphyseal separation performed without manipulation. This pediatric orthopedic service targets stabilization of the femoral growth plate after separation or fracture of the epiphyseal plate — an injury that can be clinically subtle and carries risk for growth disturbance if not properly managed. Nationally, accurate coding of epiphyseal reduction is important for clinical tracking, appropriate surgical care documentation, and payer adjudication of pediatric orthopedic procedures.
Key payers 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 care, and information on common billing modifiers and payer considerations where data are available. The publication reviews benchmark elements relevant to hospital and ambulatory surgery settings, highlights policy and coding points that affect claims submission, and summarizes clinical implications for pediatric orthopedic management.
This executive summary provides clinicians, coders, and policy analysts with a clear overview of the service represented by CPT code 27516, the primary payer landscape, and the topics covered in the full publication.
Billing Code Overview
CPT code 27516 describes a closed reduction of distal femoral epiphyseal separation without manipulation. The procedure stabilizes and reduces separation of the epiphysis at the lower end of the femur (thigh bone), addressing a growth-plate (epiphyseal) injury commonly seen in young children. The primary goal is to restore alignment of the distal femoral epiphysis to promote proper healing and minimize growth disturbance.
Service type: Orthopedic closed reduction for pediatric growth-plate injury
Typical site of service: Hospital operating room or outpatient surgical center, depending on patient age, clinical stability, and facility resources.
Clinical & Coding Specifications
Clinical Context
A typical patient is a child or adolescent who presents to the emergency department or pediatric orthopedic clinic after a fall, sports injury, or blunt trauma to the distal thigh or knee. The patient reports localized pain, swelling, reduced range of motion, and reluctance to bear weight. Physical exam demonstrates tenderness over the distal femoral physis and possible deformity. Plain radiographs (AP and lateral) are obtained to assess for distal femoral epiphyseal separation or Salter-Harris type injury. When imaging confirms a closed distal femoral epiphyseal separation without the need for open surgical manipulation, the orthopedic provider performs a closed reduction under appropriate analgesia or sedation to realign and stabilize the epiphysis. Post-reduction radiographs confirm alignment. The patient is then immobilized (cast or splint), advised on activity restrictions, scheduled for follow-up imaging and clinic visits to monitor growth plate healing and detect potential growth disturbance, and given instructions for pain control and signs of complications such as neurovascular compromise or infection.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier; standard reporting | Use for routine submission when no modifier applies |
22 |