How much does Medicare pay for CPT 27786?

Medicare allowed an average of $322.63 per service and paid $251.16 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1398.36, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 27786?

Closed treatment of broken outside lower leg bone at ankle. It was billed 1,087 times to 1,086 Medicare beneficiaries by 69 providers in 2024.

Does 27786 pay differently in an office than a hospital?

Yes. The allowed amount averaged $324.29 in an office setting and $269.66 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 27786 most?

Orthopedic Surgery, with 608 services from 41 clinicians. Next are Podiatry, Physician Assistant, Nurse Practitioner.

CPT 27786

Closed treatment of broken outside lower leg bone at ankle

$322.63Medicare-allowed amount per service, averaged across 1,087 services

Providers submitted

$1398.36

Asking price, not received

Medicare allowed

$322.63

The fee schedule figure

Medicare paid

$251.16

Balance is patient coinsurance

Providers submitted an average of $1398.36 for this code and Medicare allowed $322.63 — 4.3× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $251.16 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $324.29
Hospital / facility: $269.66

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 1,054 services were billed in an office setting and 33 in a facility.

Services: 1,087
Beneficiaries: 1,086
Providers billing it: 69
Total allowed: $350,699

What Medicare pays for CPT 27786

Across 1,087 services billed by 69 providers to 1,086 beneficiaries, Medicare allowed an average of $322.63 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 27786

Specialty	Services	Beneficiaries	Avg allowed	Providers
Orthopedic Surgery	608	607	$326.03	41
Podiatry	379	379	$335.61	21
Physician Assistant	87	87	$258.48	6
Nurse Practitioner	13	13	$214.91	1

27786 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Pennsylvania	201	$331.00	$245.32	10
Florida	171	$317.91	$244.26	11
New Jersey	138	$341.18	$251.83	8
New York	136	$363.98	$253.31	9
Massachusetts	78	$316.48	$227.23	5
South Carolina	74	$284.73	$236.68	4
California	53	$350.63	$252.58	4
Iowa	32	$275.40	$230.18	2
Missouri	27	$246.63	$214.49	2
Virginia	27	$304.61	$245.97	2
Maryland	26	$344.52	$251.37	2
Illinois	26	$317.37	$255.58	2
Ohio	15	$269.33	$245.80	1
Louisiana	13	$282.73	$245.79	1
New Mexico	13	$251.92	$208.81	1
Georgia	12	$291.92	$235.97	1
Indiana	12	$283.40	$235.80	1
Alabama	11	$280.36	$236.95	1
Connecticut	11	$329.73	$244.13	1
Michigan	11	$306.94	$203.76	1

Related codes

27702Reconstruction of ankle joint$1162.59

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.