Summary & Overview
CPT 27768: Closed Manipulation of Medial Malleolus Fracture
CPT code 27768 covers closed manipulation of a medial malleolus fracture to restore and maintain anatomic alignment, relieve pain, and prevent displacement during healing. This procedure is a common orthopedic intervention for ankle fractures and matters nationally because proper early alignment reduces the need for more complex surgery, shortens recovery, and affects downstream utilization and costs. Key payers in national analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find clinical context on when closed manipulation is applied versus other fracture treatments, typical sites of service such as ambulatory surgical centers and hospital outpatient departments, and operational considerations for coding and billing. The publication summarizes benchmarking data, payer coverage patterns, and recent policy updates that affect authorization and site-of-service decisions. It also highlights documentation elements required to support medical necessity and typical clinical indications. Data not available in the input are identified where applicable.
Billing Code Overview
CPT code 27768 describes closed treatment of a medial malleolus fracture with manipulation of the fracture fragments to restore anatomic alignment. The procedure is performed to maintain alignment and prevent displacement while the fracture heals and to relieve pain.
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Service type: Fracture management with closed manipulation (orthopedic procedure)
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Typical site of service: Ambulatory surgical center or hospital outpatient department; may also be performed in an emergency department or operating room depending on clinical acuity and need for sedation or imaging
Clinical & Coding Specifications
Clinical Context
A 42-year-old male sustained an isolated medial malleolus fracture after a fall from a ladder. He presents to the emergency department with ankle pain, swelling, and inability to bear weight. Radiographs confirm a displaced medial malleolar fracture. The orthopedic surgeon performs a closed manipulation of fracture fragments under procedural sedation in the operating room or procedure suite to restore anatomic alignment and relieve pain, followed by immobilization in a plaster cast or splint. Post-manipulation radiographs confirm alignment; the patient is discharged with instructions for non–weight bearing and scheduled for follow-up within one week for repeat imaging and evaluation for definitive fixation if instability persists.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier used / default | Rarely appended; indicates standard service without additional modifiers when required by payer systems |
11 | Primary (default) | Use when this service is the primary procedure performed during the encounter |