Surgical · Hip

Surgical incision through the bone cortex of the pelvis and/or hip joint to drain infection or abscess — typically performed for osteomyelitis or a bone abscess in that region.

Verified May 8, 2026 · 7 sources ↓

Medicare: $944.91
Total RVUs: 28.29
Global, days: 90
Region: Hip

Drawn from CMSFastrvuNIHBedrockbillingBonesupport

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify the diagnosis driving the procedure — osteomyelitis vs. bone abscess — with supporting imaging or culture results referenced in the operative note.
Document that the incision was made through the bone cortex, not just surrounding soft tissue; distinguish from a simple I&D of a bursa or abscess.
Identify the anatomic site explicitly (pelvis, femoral neck, acetabulum, proximal femur) rather than using generic terms like 'hip area'.
Record intraoperative findings: character and volume of drainage, presence of necrotic bone, cultures sent, and any irrigation performed.
Note the surgical approach and patient positioning to support medical necessity and distinguish from less invasive alternatives.
Include preoperative antibiotics, culture-directed therapy history, and failed conservative management to justify operative intervention.

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 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 7 cited references ↓

CPT 26992 covers open incision of the pelvic or hip joint bone cortex to drain an infectious lesion — osteomyelitis and bone abscesses are the canonical indications. The surgeon penetrates the cortex to decompress and evacuate purulent or infected material. This is not a soft-tissue I&D; the target is the bone itself, distinguishing it from 26990 (deep abscess or hematoma of the hip/pelvis soft tissue) and 26991 (infected bursa).

This code carries a 90-day global period, meaning routine follow-up wound checks, dressing changes, and postoperative visits through day 90 are bundled. Any E/M visit for an unrelated problem in that window requires modifier 24. A new or worsening infectious complication requiring a return to the OR during the global period is modifier 78 (related, unplanned). An unrelated surgical problem in the postoperative period uses modifier 79.

CMS has historically assigned 26992 inpatient-only status under HOPD rules, meaning it cannot be billed under the Outpatient Prospective Payment System (OPPS) — only as an inpatient hospital procedure or in an ASC where separately payable. Confirm current status indicator in the CMS 2026 OPPS Addendum B before scheduling site of service, as inpatient-only designations are reviewed annually.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	13.14
Practice expense RVU	12.28
Malpractice RVU	2.87
Total RVU	28.29
Medicare national rate	$944.91
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	$944.91
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI G2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 26992 get rejected.

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

Site-of-service mismatch: 26992 has been designated inpatient-only under OPPS; billing it as a hospital outpatient procedure triggers automatic denial.
Insufficient medical necessity documentation — payers require evidence of bone involvement (MRI, CT, or bone scan) and failed non-surgical management before approving an open cortical incision.
Unbundling conflict: billing 26992 alongside a same-session soft-tissue I&D code (26990 or 26991) without modifier 59/XS when NCCI edits bundle them.
Global period billing errors: posting a related E/M visit within the 90-day global without modifier 24, resulting in denial as included post-op care.
Missing or vague operative note — audit reviewers flag notes that don't explicitly state cortical incision, defaulting the denial to the less complex soft-tissue drainage code.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What distinguishes 26992 from 26990?

26990 is for deep soft-tissue abscess or hematoma of the pelvis/hip area. 26992 requires that the surgeon actually incise the bone cortex — the infection target is the bone itself, not the surrounding soft tissue. The operative note must state cortical incision explicitly.

02Can 26992 be performed in an ASC?

CMS has historically listed 26992 as inpatient-only under OPPS, blocking outpatient hospital billing. ASC payment does exist per the fee schedule data, but verify current CMS Addendum B status for 2026 before scheduling — inpatient-only designations are reviewed each year.

03What modifier is needed for a return to the OR during the 90-day global for a wound complication?

Use modifier 78 for an unplanned return to the OR for a complication related to the original procedure (e.g., persistent or recurrent bone infection requiring re-drainage). Modifier 79 is for a truly unrelated surgical procedure during the postoperative period.

04Does 26992 cover bone grafting or dead bone removal performed at the same session?

No. 26992 covers the cortical incision and drainage only. Sequestrectomy or partial excision of necrotic bone is a separate procedure. If both are performed, report the additional code with modifier 51 and document each distinct procedure in the operative note.

05What ICD-10 diagnosis codes support medical necessity for 26992?

Osteomyelitis codes (M86.x series, specific to pelvis/hip) and bone abscess are the primary supporting diagnoses. Chronic osteomyelitis with draining sinus (M86.4x) or acute hematogenous osteomyelitis (M86.0x) of the pelvic region are the clearest matches. Payers will scrutinize any claim where the linked diagnosis doesn't reflect bone-level infection.

06Is modifier 50 appropriate for 26992?

Only if the procedure is genuinely performed bilaterally — both hips or bilateral pelvic bone lesions drained at the same session. That is clinically rare for osteomyelitis. If billed, document bilateral involvement explicitly in the operative note and verify payer-specific bilateral payment rules before appending modifier 50.

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 procedure site (pelvis vs. proximal femur), confirms documentation of cortical incision versus soft-tissue drainage, logs intraoperative findings including drainage character and cultures sent, and flags the diagnosis code (osteomyelitis vs. bone abscess) against imaging referenced in the note. This prevents the most common denial path: a vague operative report that auditors recode down to 26990 or reject for lack of bone-level involvement.

See how Mira captures CPT 26992 documentation