CPT 27519 Open Reduction Reimbursement | OpenPayer

Summary & Overview

CPT 27519: Open Reduction of Distal Femoral Epiphyseal Separation

CPT code 27519 covers open reduction and possible internal fixation of distal femoral epiphyseal separations, a pediatric orthopedic procedure to realign and stabilize the distal femoral growth plate. This code is used when the epiphyseal plate is separated or fractured and requires surgical management to restore alignment and protect future growth. Nationally, proper coding for these injuries affects surgical billing, resource allocation, and complication tracking in pediatric orthopedic care.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code's clinical intent and typical settings, plus what to expect in benchmarking and policy context at a national level. The publication summarizes common billing practices, payer coverage patterns, and potential areas of coding scrutiny for growth plate injuries in young children.

This report also provides clinical context for the procedure, outlines typical site-of-service considerations, and identifies data elements that are available or not available from the input. Data not available in the input include specific ICD-10 mappings, related CPT codes, and payer-specific reimbursement rates.

AetnaBlue Cross Blue ShieldCignaUnitedHealthcareMedicareCPT 27519distal femoral epiphyseal separationpediatric orthopedicsopen reductioninternal fixationsurgical codingorthopedic surgerygrowth plate injuryhospital outpatient surgery

Billing Code Overview

CPT code 27519 describes an open reduction with possible internal fixation of a distal femoral epiphyseal separation. The procedure focuses on realigning the distal femoral epiphysis (growth plate) and stabilizing the epiphysis to restore anatomic alignment and preserve growth potential when the epiphyseal plate is separated or fractured.

Service Type: Surgical — open reduction with possible internal fixation of pediatric distal femoral epiphyseal separation

Typical Site of Service: Operating room or surgical suite in an inpatient or outpatient hospital setting

Clinical & Coding Specifications

Clinical Context

A 9-year-old child presents to the emergency department after a fall from a bicycle with immediate pain, swelling, deformity, and inability to bear weight on the affected leg. Clinical exam and radiographs demonstrate a displaced distal femoral physeal (epiphyseal) separation. Orthopaedic consultation is obtained. The patient is taken to the operating room for open reduction and possible internal fixation of the distal femoral epiphyseal separation under general anesthesia. The clinical workflow includes preoperative evaluation and consent, radiographic confirmation (AP and lateral films), induction of anesthesia, open reduction of the physis with careful preservation of the growth plate, internal fixation if required to stabilize the epiphysis (pins, screws, or small plates placed to avoid physeal damage), intraoperative fluoroscopic imaging to confirm alignment and hardware position, wound closure, recovery from anesthesia, and postoperative immobilization and outpatient follow-up for cast/splint care and serial radiographs to monitor healing and growth plate status. Typical recovery includes short inpatient observation for pain control and neurovascular monitoring, discharge with activity restrictions, and scheduled clinic visits for radiographic follow-up and hardware removal if indicated.

Coding Specifications

Modifier	Description	When to Use
`62`	Two surgeons	When two surgeons work together as primary surgeons performing distinct parts of the procedure on the same patient and same operative session.

CPT 27557: Open Reduction, Internal Fixation of Dislocated Knee with Ligament Repair

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

CPT 27540: ORIF of Intercondylar Spine or Tuberosity of Knee

CPT-27560-CLOSED-REDUCTION-PATELLAR-DISLOCATION

CPT 27560: Closed Reduction of Dislocated Patella

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

CPT 27506: Open Intramedullary Fixation of Femoral Shaft Fracture

CPT-27508-CLOSED-REDUCTION-DISTAL-FEMUR-CONDYLAR-FRACTURE

CPT 27508: Closed Reduction of Distal Femur Condylar Fracture

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

CPT 27532: Closed Reduction, Bicondylar Proximal Tibial Plateau Fracture

CPT-27524-PATELLAR-FRACTURE-ORIF-PATELLECTOMY-SOFT-TISSUE-REPAIR

CPT 27524: Open Reduction Internal Fixation of Patellar Fracture with Patellectomy and Soft Tissue Repair

CPT-27514-OPEN-REDUCTION-INTERNAL-FIXATION-FEMORAL-CONDYLE-FRACTURE

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

CPT-27517-CLOSED-REDUCTION-DISTAL-FEMORAL-EPIPHYSEAL-SEPARATION

CPT 27517: Closed Reduction, Distal Femoral Epiphyseal Separation

CPT-27535-UNICONDYLAR-PROXIMAL-TIBIAL-PLATEAU-OPEN-REDUCTION-INTERNAL-FIXATION

CPT 27535: ORIF of Unicondylar Proximal Tibial Plateau Fracture

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Taxonomy Code	Specialty	Notes
207L00000X	Orthopaedic Surgery	Pediatric and trauma orthopaedic surgeons commonly perform open reduction and fixation of distal femoral physeal injuries.
2080P0208X	Pediatric Orthopedic Surgery	Specialists in pediatric orthopedics focus on growth plate injuries and development, frequently managing distal femoral epiphyseal separations.
208000000X	General Surgery (Orthopedics not always separate)	General orthopaedic surgeons or trauma surgeons in some settings perform this procedure when pediatric subspecialists are unavailable.
2086S0102X	Emergency Medicine	Emergency physicians often provide initial assessment and stabilization and coordinate operative care for urgent physeal separations.
363L00000X	Anesthesiology	Anesthesiologists provide general anesthesia for pediatric orthopedic operative procedures and perioperative care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S72.091A`	Salter-Harris type I fracture of lower end of right femur, initial encounter	Distal femoral epiphyseal separation in the right femur; direct indication for open reduction and fixation when displaced.
`S72.092A`	Salter-Harris type I fracture of lower end of left femur, initial encounter	Distal femoral epiphyseal separation in the left femur; direct indication for open reduction and fixation when displaced.
`S72.111A`	Salter-Harris type II fracture of lower end of right femur, initial encounter	Physeal fracture with metaphyseal involvement requiring operative stabilization depending on displacement.
`S72.112A`	Salter-Harris type II fracture of lower end of left femur, initial encounter	As above for the left side; commonly associated with procedures to restore anatomic alignment.
`S72.151A`	Other fracture of lower end of right femur, initial encounter for closed fracture	Non-Salter-Harris distal femoral fractures that may require open reduction and internal fixation.
`S72.152A`	Other fracture of lower end of left femur, initial encounter for closed fracture	Contralateral equivalent; indicates distal femoral fracture management including possible `27519`.
`M84.371A`	Pathological fracture, right femur, initial encounter	Pathologic physeal separation or fracture requiring operative fixation when due to underlying bone disease; less common but clinically relevant.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27320`	Open treatment of femoral supracondylar fracture, includes internal fixation when performed	Performed for distal femoral fractures in older children or adolescents; may be used for metaphyseal fractures adjacent to the physis and is a closely related technique.
`20690`	Insertion of implantable intramedullary prosthetic or fixation device (e.g., for small bone)	May be used when internal fixation devices or pins are placed across or adjacent to the distal femur; selected based on hardware type.
`20670`	Percutaneous skeletal fixation of fracture (pinning)	Commonly performed when closed or percutaneous pinning is used instead of open reduction; can be performed before or instead of `27519` if open reduction is not required.
`77002`	Fluoroscopic guidance for interventional procedure	Intraoperative fluoroscopic imaging guidance used during reduction and hardware placement; often billed by the facility or imaging provider depending on payer rules.
`99024`	Postoperative follow-up visit global period (by surgeon)	Used for routine postoperative follow-up visits during the global period to document healing and progress after fixation of the distal femoral epiphysis.
`20680`	Removal of implanted internal fixation device, deep (requiring more extensive exposure)	May be required weeks to months after the index procedure for hardware that must be removed under anesthesia; related to the care continuum after `27519`.

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