CPT 27722 Tibial Nonunion Repair Reimbursement | OpenPayer

Summary & Overview

CPT 27722: Repair of Tibial Nonunion/Malunion with Sliding Bone Graft

CPT code 27722 represents a surgical repair of a tibial fracture that has healed improperly or failed to heal, using a sliding bone graft between fragments to restore alignment, relieve pain, and improve function. This code captures a specialized orthopedic reconstructive procedure commonly performed after conservatively managed fractures or prior surgical failures. Nationally, accurate coding of 27722 matters for appropriate surgical reimbursement, outcome tracking for nonunion/malunion management, and reporting of operative orthopedic services.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical context for when 27722 is used, the typical sites of service, and the scope of payers that commonly adjudicate claims for this procedure. The publication outlines common billing considerations, typical care settings (hospital OR and ambulatory surgical centers), and where stakeholders should expect variability in coverage and prior authorization practices.

This summary equips coders, billing managers, and orthopedic clinicians with a clear understanding of the procedure represented by CPT code 27722, the national payer landscape involved, and the practical topics covered in the full publication such as billing benchmarks, coding nuances, and policy updates. Data not available in the input for detailed payer-specific rates or diagnosis pairings is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare27722CPTorthopedic surgerytibianonunionmalunionbone graftoperative procedure

Billing Code Overview

CPT code 27722 describes a surgical procedure to repair a tibial nonunion or malunion by placing a sliding bone graft between the fractured fragments. The service is an operative orthopedic revision of a healed improperly or non-healed tibial fracture intended to restore function and relieve pain.

Service type: Surgical orthopedic procedure (tibial nonunion/malunion repair with sliding bone graft)
Typical site of service: Hospital operating room or ambulatory surgical center where orthopedic reconstructive procedures are performed

Clinical & Coding Specifications

Clinical Context

A 38-year-old male sustained a tibial shaft fracture 9 months ago that has healed with malalignment and persistent pain and dysfunction. He reports difficulty weightbearing and recurrent instability of the lower leg despite conservative management including physical therapy and bracing. Imaging (AP, lateral radiographs and CT) demonstrates a nonunion with short oblique deformity and a bony gap between tibial fragments. The orthopedic trauma surgeon schedules an open revision of the tibial nonunion with osteotomy and placement of a sliding intercalary bone graft to restore alignment and promote union.

Preoperative workflow includes history and physical, informed consent discussing risks of infection, neurovascular injury, and need for bone grafting; preop labs and cardiopulmonary evaluation as indicated; templating and graft planning. Intraoperative steps typically include exposure of the nonunion site, debridement of fibrous tissue, preparation of bone ends, creation of a sliding corticocancellous bone graft segment, placement of the sliding graft into the interfragmentary gap, fixation (plate and screws or intramedullary nail as clinically indicated), and evaluation of alignment and stability. Postoperative care includes pain control, DVT prophylaxis, wound checks, graduated weightbearing per fixation and bone quality, and follow-up radiographs to document progressive healing.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier – standard reporting

CPT 27724: Repair of Tibial Nonunion or Malunion with Bone Graft

CPT-27715-TIBIA-FIBULA-LENGTHENING-SHORTENING-LEG-LENGTH-CORRECTION

CPT 27715: Tibia and Fibula Lengthening or Shortening

CPT-27702-TOTAL-ANKLE-REPLACEMENT-RECONSTRUCTION-WITH-IMPLANT

CPT 27702: Total Ankle Reconstruction with Implant

CPT-27709-TIBIA-FIBULA-OSTEOTOMY-DEFORMITY-CORRECTION

CPT 27709: Tibia and Fibula Osteotomy for Deformity Correction

CPT-27690-TENDON-TRANSFER-TRANSPLANT-LOWER-EXTREMITY

CPT 27690: Single Tendon Transfer or Transplant

CPT-27685-TENDON-REPAIR-LEG-FOOT

CPT 27685: Tendon Repair for Leg or Foot Deformity

CPT-27740-TIBIAL-FIBULAR-GROWTH-INTERRUPTION-EPIPHYSIODESIS

CPT 27740: Tibial and Fibular Growth Plate Fusion for Leg-Length Equalization

CPT-27650-ACHILLES-TENDON-PRIMARY-REPAIR

CPT 27650: Primary Open or Percutaneous Repair of Achilles Tendon Tear

CPT-27681-MULTIPLE-TENDON-RELEASE-LEG-ANKLE

CPT 27681: Release of Multiple Flexor or Extensor Tendons, Leg/Ankle

CPT-27659-FLEXOR-TENDON-REPAIR-LEG-REVISION

CPT 27659: Revision Repair of Flexor Tendons of the Leg

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Taxonomy Code	Specialty	Notes
207L00000X	Orthopedic Surgery	Primary specialty performing tibial nonunion repair and sliding bone grafting.
207T00000X	Orthopedic Trauma Surgery	Subspecialty often managing complex nonunions and reconstructive fixation.
208600000X	General Surgery	May be involved in complex limb salvage in multidisciplinary cases.
208100000X	Family Medicine	Not typical for procedure but may provide perioperative primary care and follow-up.
363L00000X	Physical Therapy	Provides postoperative rehabilitation and weightbearing progression.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M84.30XA`	Stress fracture, tibia and fibula, initial encounter for stress fracture	Stress fractures may progress to nonunion requiring revision and grafting if healing fails.
`S82.201A`	Unspecified fracture of shaft of tibia, right leg, initial encounter for closed fracture	Tibial shaft fractures are the typical injury that can heal improperly and later require corrective sliding bone grafting.
`S82.209A`	Unspecified fracture of shaft of tibia, left leg, initial encounter for closed fracture	Same relevance as above for the contralateral side.
`M84.151A`	Pathological fracture, right tibia, initial encounter for fracture	Pathological fractures may result in atypical healing requiring reconstructive techniques.
`M84.151D`	Pathological fracture, right tibia, subsequent encounter for fracture with delayed healing	Captures tibial fractures with delayed healing or nonunion indicating need for surgical repair.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27722`	Repair of tibial nonunion or malunion with sliding bone graft (as described)	Primary procedure: surgical correction of a tibial fracture that has healed improperly, using an intercalary sliding graft to restore length, alignment, and promote union.
`27506`	Open treatment of tibial shaft fracture, with internal fixation, includes open reduction and internal fixation	Performed when internal fixation (plate/screws) is required in addition to grafting; may be reported when fixation approach differs from code bundling rules.
`20610`	Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., knee)	Pre- or postoperative joint injections or aspiration for pain management or diagnostic evaluation; not typically bundled with open tibial procedures.
`11030`	Debridement including removal of foreign material and/or necrotic tissue	Reported for extensive wound debridement separate from the standard exposure and nonunion site preparation when documentation supports additional work.
`20926`	Autograft, osteochondral or corticocancellous, from iliac crest, structural, when performed	Reported when additional structural autograft harvested (iliac crest) is used beyond the sliding graft technique and payer rules permit separate reporting.

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