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    OpenPayerBilling CodesRepair, Revision, and/or Reconstruction Procedures on the Leg (Tibia and Fibula) and Ankle JointCPT cpt-27724-tibia-nonunion-malunion-repair-with-bone-graft
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    CPT 27724: Tibial Fracture Repair with Bone Graft

    Medicare pays $1150 on average nationally for this procedure.

    CPT code 27724 describes surgical repair of a tibial fracture that has healed improperly (malunion) or failed to heal (nonunion), with placement of an iliac or other bone graft between tibial fragments to restore function and relieve pain; this is an open orthopedic surgical procedure typically performed in an inpatient or ambulatory surgery center setting as part of fracture reconstruction and nonunion/malunion management.

    For related coverage guidance, see recent payer policy updates: Hip Arthroplasty (partial and total hip replacement), Shoulder Arthroplasty (Total, Partial, Reverse, Revision and Resurfacing), Artificial Lumbar Intervertebral Disc (Lumbar Total Disc Arthroplasty).

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 46-year-old male presents with persistent pain, instability, and difficulty weight-bearing six months after a closed tibial shaft fracture managed conservatively with casting. Radiographs and CT demonstrate a persistent nonunion with malalignment and loss of length. The orthopedic trauma surgeon schedules an open corrective procedure to restore alignment, obtain union, and relieve pain.

    The procedure includes exposure of the tibial nonunion site, debridement of fibrous tissue, direct reduction of the bone fragments, placement of an autologous iliac crest bone graft between the fragments, and fixation with internal hardware (plate and screws or intramedullary device) to achieve stability. Intraoperative fluoroscopy is used to confirm alignment and hardware placement. The patient is typically admitted to an outpatient or inpatient surgical facility depending on comorbidities and anticipated postoperative pain control needs, with perioperative antibiotics and routine neurovascular monitoring. Postoperative care includes immobilization, pain control, physical therapy initiation as tolerated, and follow-up imaging to document progression to union.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    27486Open treatment of tibial shaft fracture, with or without internal or external fixation, with manipulation, when performed; with open reduction and internal fixation, when performedMay be used when primary fracture fixation is performed as the main service rather than a corrective nonunion repair; sometimes billed in conjunction if distinct procedures are performed.
    20936Autograft for spine or other large bone graft (e.g., iliac crest), includes obtaining graft when performedBilled for harvesting an autologous iliac crest bone graft when reported separately from the nonunion repair if payer allows separate graft harvesting code.
    20680Removal of implant; deep (e.g., buried)May be performed prior to or during nonunion repair if prior hardware is present and must be removed.
    73030Radiologic examination, ankle and foot; complete, minimum of 3 viewsPreoperative and postoperative radiographs of the tibia/ankle region; radiology codes are part of the perioperative workflow.
    27488Open treatment of tibial shaft fracture, with or without internal or external fixation, with manipulation, when performed; with intramedullary implant (e.g., rod)Relevant if intramedullary fixation is used to stabilize the nonunion after grafting.

    Related Modifiers

    11 rows

    ModifierDescriptionWhen to Use
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    81Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…
    58Modifier 58 (Staged or related procedure/service by the same physician during the postoperative period) indicates that a subsequent procedure performed by the same provider during the…- Use modifier 58 when the same physician/QHP performs a procedure during the postoperative/global period of an earlier procedure and the subsequent procedure is either planned or anticipated…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…

    Showing 1–10 of 11

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    207X00000XOrthopaedic Surgery PhysicianAn orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated…
    207RH0002XHospice and Palliative Medicine (Internal Medicine) PhysicianAn internal medicine physician with special knowledge and skills to prevent and relieve the suffering experienced by patients with life-limiting illne…
    2278P1005XPulmonary Rehabilitation Certified Respiratory TherapistThe respiratory therapist can assist the chronic pulmonary patient in returning to an optimal role in society by providing an effective program. It i…
    213EG0000XDeactivated - Podiatrist
    261QA0005XAmbulatory Family Planning FacilityAn abortion/family planning facility where services are provided at a fixed specific location. An Ambulatory Family Planning Facility does not provid…
    207WX0107XRetina Specialist (Ophthalmology) PhysicianAn ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases.
    363LX0106XOccupational Health Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner

    Related Payer Policy Updates

    Specialty: Orthopedics/Musculoskeletal1 / 3

    7 rows

    PolicyPayerEffective Date
    Hip Arthroplasty (partial and total hip replacement)univerahealthcare2026-10-15
    Shoulder Arthroplasty (Total, Partial, Reverse, Revision and Resurfacing)univerahealthcare2026-10-15
    Artificial Lumbar Intervertebral Disc (Lumbar Total Disc Arthroplasty)univerahealthcare2026-10-15
    Metal-on-Metal Total Hip Resurfacinguniverahealthcare2026-10-15
    Lumbar Fusion (arthrodesis) with decompressionuniverahealthcare2026-10-15
    Osteochondral Grafting of the Kneeuniverahealthcare2026-10-15
    Sacroiliac Joint Fusion or Stabilizationuniverahealthcare2026-10-15

    Related Codes

    CPT-27650-ACHILLES-TENDON-PRIMARY-REPAIR

    CPT 27650: Primary Repair of Achilles Tendon Tear

    CPT-27652-ACHILLES-TENDON-REPAIR-WITH-GRAFT

    CPT 27652: Achilles Tendon Repair with Graft

    CPT-27654-ACHILLES-TENDON-REPAIR-REPEAT-REVISION

    CPT 27654: Repair of Achilles Tendon, Revision

    CPT-27656-LEG-FASCIA-RECONSTRUCTION-REPAIR

    CPT 27656: Repair of Leg Fascia

    CPT-27658-FLEXOR-TENDON-REPAIR-LEG-PRIMARY

    CPT 27658: Primary Repair of Flexor Tendon(s) of Leg

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

    CPT 27659: Repair of Flexor Tendons of the Leg (Revision)

    CPT-27664-EXTENSOR-TENDON-REPAIR-LEG-PRIMARY-REPAIR-NO-GRAFT

    CPT 27664: Primary Repair of Extensor Tendon of Leg without Graft

    CPT-27665-EXTENSOR-TENDON-REPAIR-LEG-REVISION

    CPT 27665: Repair of Extensor Tendon(s) of Leg, Revision

    CPT-27675-PERONEAL-TENDON-REPAIR-DISLOCATION

    CPT 27675: Repair of Dislocated Peroneal Tendons Without Fibular Osteotomy

    CPT-27676-PERONEAL-TENDON-STABILIZATION-FIBULAR-GROOVE

    CPT 27676: Peroneal Tendon Repair with Fibular Groove Creation

    Showing 1–10 of 42

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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