Incision and drainage of an infected bursa located in the pelvis or hip joint area, performed to evacuate purulent material and resolve infection.

Verified May 8, 2026 · 5 sources ↓

Medicare: $744.84
Total RVUs: 22.3
Global, days: 90
Region: Hip

Drawn from AAPCAbosCMSMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Confirm drainage target is the bursa, not the hip joint — operative note must state depth of dissection and anatomic structure entered
Document clinical indication: infection confirmed by exam findings, imaging, or intraoperative appearance (purulence, erythema, fluctuance)
Record presence or absence of joint penetration to distinguish 26991 from 27030
Note laterality (left, right, or bilateral) and any irrigant used or drain placed
Include pre-op imaging or lab results supporting infectious etiology (e.g., elevated WBC, CRP, MRI findings) when prior auth is required
For modifier 78 use, document that the return to the OR was unplanned and directly related to the original procedure's complication

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 52 Reduced services 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 26991 describes open incision and drainage of an infected bursa in the pelvis or hip joint region. The surgeon incises down to the bursa — not into the joint itself — evacuates pus, and may irrigate the cavity. This distinguishes 26991 from 26990, which covers a deep abscess or hematoma in the same region, and from 27030, which applies when the surgeon enters the hip joint proper. Getting the depth right in the operative note is the single most common audit trigger for this family of codes.

The procedure carries a 90-day global period. All routine follow-up, wound checks, and dressing changes through postoperative day 90 are bundled. If a separate, unrelated E/M or procedure is needed in that window, append modifier 24 or 79 as appropriate. Per NCCI policy, incision and drainage cannot be billed separately when performed solely to gain access for another procedure at the same site on the same date.

This code appears most frequently under Plastic and Reconstructive Surgery in CMS utilization data, reflecting its use in managing postoperative wound complications and pressure-related bursitis in complex patients. Site of service matters: HOPD and ASC reimbursement differ — see the site-of-service comparison table on this page.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.88
Practice expense RVU	14.01
Malpractice RVU	1.41
Total RVU	22.3
Medicare national rate	$744.84
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	$744.84
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 26991 get rejected.

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

Code billed when surgeon entered the joint — payer or auditor downcodes or denies in favor of 27030
Bundling denial when 26991 is billed same-day as another procedure at the same anatomic site without a compliant modifier
Global period violation — follow-up I&D or wound care billed without modifier 78 or 79 within 90-day global window
Missing or vague laterality — payer rejects claim lacking LT/RT when bilateral rules apply
Insufficient documentation of infectious etiology — payer denies medical necessity when operative note lacks clinical indicators of infection

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What is the difference between CPT 26990 and 26991?

26990 covers incision and drainage of a deep abscess or hematoma in the pelvis or hip area. 26991 is specific to an infected bursa. The distinction rests on the structure drained — bursal infection gets 26991; a non-bursal deep abscess or hematoma gets 26990.

02When should 27030 be used instead of 26991?

Use 27030 when the surgeon opens and drains the hip joint itself. 26991 applies only when drainage is limited to the bursa. If the operative note says the surgeon went down to the joint, 26991 is the wrong code — and many payers will reprocess to 27030 or deny outright.

03Can 26991 be billed same-day as a hip arthroplasty or other major hip procedure?

Only if the I&D is at a separate anatomic site or clearly distinct from the access used for the primary procedure. NCCI policy prohibits billing I&D separately when it is performed solely to gain access for another procedure at the same site. Append modifier 59 or XS only when documentation supports a genuinely separate service.

04What modifiers apply when 26991 is performed during the global period of a prior hip procedure?

If the return to the OR is unplanned and the I&D addresses a complication of the original surgery, use modifier 78. If it is unrelated to the original procedure, use modifier 79. Modifier 24 applies to an unrelated E/M visit in the global period. Do not use 78 and 79 interchangeably — auditors flag inversions.

05Does 26991 require prior authorization?

Authorization requirements vary by payer and plan. Emergent or urgent presentations are often exempt, but elective or staged drainage in a managed care patient frequently requires prior auth. Some Medicaid managed care plans and commercial payers require imaging or lab evidence of infection before approving. Verify with each payer before scheduling non-urgent cases.

06Is 26991 ever performed bilaterally, and how is that billed?

Bilateral pelvic bursa drainage is uncommon but possible. If performed, append modifier 50 and bill on a single line. Some payers instead want LT and RT on separate lines — verify the payer's bilateral billing preference before submitting.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the surgeon's dictation for the anatomic target (bursa vs. joint), depth of dissection, presence of purulence, any irrigation performed, drain placement, and laterality. This prevents the most common audit flag — an operative note that fails to confirm the surgeon stopped at the bursa rather than entering the hip joint, which triggers downcoding to 27030 or an outright denial.

See how Mira captures CPT 26991 documentation