Incision and drainage of a deep abscess or hematoma located in the pelvis or hip joint area.

Verified May 8, 2026 · 8 sources ↓

Medicare: $660.67
Work RVU: 7.75
Global, days: 90
Region: Hip

Drawn from CMSFindacodeGenhealthAAPCPayerprice

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 8 cited references ↓

Confirm depth: operative note must explicitly describe the abscess or hematoma as deep, not superficial or subcutaneous.
Specify anatomic location within the pelvis or hip joint area — vague terms like 'hip region' are insufficient for audit defense.
Document approach and extent of drainage, including irrigation, packing, or drain placement if performed.
Record intraoperative findings — size of collection, character of fluid (purulent vs. sanguineous), tissue planes entered.
If performed post-arthroplasty, document relationship to prior procedure to support modifier 78 (related) or 79 (unrelated) as applicable.
Anesthesia type and personnel must be noted to support facility-level billing.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 50 Bilateral procedure 51 Multiple procedures 58 Staged or related 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

CPT 26990 covers surgical incision and drainage of a deep abscess or hematoma in the pelvis or hip joint region. This is not a superficial wound drainage — the depth qualifier is critical. The procedure requires operative-level access, typically performed in a hospital OR or ASC under general or regional anesthesia, with a surgical team present. Common clinical scenarios include post-arthroplasty hematoma, septic processes adjacent to the hip joint, and deep soft-tissue infections in the pelvic girdle.

The code carries a 90-day global period. Any related E/M or procedure billed within that window — including management of infection recurrence or wound complications tied to the same site — requires modifier 24 or 78, respectively. Unrelated procedures in the global window need modifier 79. Document clearly that the abscess or hematoma is deep; superficial drainage in the same anatomic region does not support this code.

Related codes in the same incision series include 26991 (infected bursa) and 26992 (deep incision with bone cortex opening). Choosing the wrong code within this cluster is a common audit flag. If hardware removal or joint washout is performed at the same session, additional codes may apply — each must be independently supported by the operative note.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (7.75) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (19.78) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.75
Practice expense RVU	10.35
Malpractice RVU	1.68
Total RVU	19.78
Medicare national rate	$660.67
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$660.67
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 26990 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Depth not documented — payer downcodes to superficial I&D when 'deep' is not explicitly stated in the operative note.
Global period conflict — procedure billed within 90-day global of a prior surgery without modifier 78 or 79, triggering automatic denial.
Wrong code selection — 26991 (bursa) or 26992 (bone cortex) billed when 26990 criteria are met, or vice versa, flagged on audit.
Missing or inadequate operative report — facility claims denied when the note does not support OR-level resource utilization.
Laterality absent on claim — payers expecting LT/RT modifier flag the line when it is missing for a unilateral procedure.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01What makes 26990 'deep' — is there a defined tissue plane threshold?

No hard anatomic rule exists in CPT, but the operative note must show the surgeon dissected through fascia into deep soft tissue or the periarticular space. Subcutaneous collections in the hip region do not support 26990.

02If the patient returns to the OR for re-drainage of the same abscess, what modifier applies?

Use modifier 78 — unplanned return to the OR for a complication related to the original procedure during the global period. Modifier 79 is for unrelated procedures only. Inverting these is a common audit finding.

03Can 26990 be billed with a hip arthroplasty code on the same date?

Rarely, and only if the I&D is a clearly distinct, separately documented procedure at a different site or for a different pathology. Expect NCCI scrutiny. Modifier 59 or XS may apply, but the operative note must support separate work.

04Does the 90-day global apply to the treating surgeon only, or the entire group?

CMS applies the global period to the individual surgeon NPI. However, many commercial payers apply it at the group or TIN level. Verify payer policy before billing a same-group provider's post-op visit.

05When should modifier 22 be used with 26990?

Use modifier 22 when the procedure required substantially more work than typical — for example, a multi-loculated abscess requiring extensive dissection, or a morbidly obese patient with significantly increased operative time. Attach a cover letter with supporting documentation; expect payer review.

06Is 26990 appropriate for post-THR seroma drainage in the OR?

If the seroma is deep and the procedure requires formal incision in the OR, 26990 can apply. Confirm the collection meets the depth threshold and that the note distinguishes this from simple wound care. If joint exchange or component work was also done, additional codes may be warranted.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures the depth descriptor, anatomic location, fluid character, tissue planes entered, and drain or packing details from surgeon dictation — the exact elements auditors check first on a 26990 claim. It also flags the prior-surgery date automatically so the coder knows whether modifier 78 or 79 applies before the claim is built, preventing 90-day global denials before they happen.

See how Mira captures CPT 26990 documentation