Open surgical division of the hip adductor tendon combined with obturator neurectomy, performed through a direct incision.

Verified May 8, 2026 · 5 sources ↓

Medicare: $571.49
Work RVU: 7.61
Global, days: 90
Region: Hip

Drawn from CMSAAPCCgsmedicareAAOS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Operative note must explicitly confirm open surgical approach — not percutaneous
Document that obturator neurectomy was performed, not merely retracted or visualized
Specify laterality (left, right, or bilateral) in both the operative note and the claim
Record the clinical indication tying spasticity or fixed contracture to the adductor muscle and obturator nerve
Pre-operative documentation of failed conservative management (physical therapy, nerve blocks, or botulinum toxin) supports medical necessity
Neurological or orthopaedic diagnosis tying to ICD-10 (e.g., spastic cerebral palsy, post-stroke spasticity) must appear in the assessment and plan

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 25 Significant separate E/M 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 62 Co-surgeons 74 Discontinued post-anesthesia 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 5 cited references ↓

CPT 27003 covers an open adductor tenotomy of the hip paired with obturator neurectomy — two distinct steps performed through the same incision. The surgeon divides the adductor tendon to relieve spasticity or fixed hip adduction contracture, then resects or interrupts the obturator nerve to reduce the neurogenic drive causing the deformity. This combination is most common in patients with cerebral palsy, spastic paraplegia, or similar upper motor neuron conditions where the adductor spasticity is both structural (tendon) and neurogenic (nerve).

The 90-day global period applies. All routine post-op visits, wound checks, and suture removal through day 90 are bundled — bill unrelated E/M visits in that window with modifier 24. The procedure is bilateral in many spasticity cases; when both hips are addressed in the same operative session, report with modifier 50 (or LT/RT on separate lines for ASC claims). Document which side(s) are treated and confirm the neurectomy was performed — not just the tenotomy — because 27003 is a more extensive procedure than 27000 (percutaneous adductor tenotomy) and requires operative note language that supports the open approach and nerve work.

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 (7.61) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (17.11) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.61
Practice expense RVU	7.87
Malpractice RVU	1.63
Total RVU	17.11
Medicare national rate	$571.49
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	$571.49
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 27003 get rejected.

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

Upcoding flag: payer downcodes to 27000 (percutaneous) when the operative note doesn't clearly document the open incision and nerve resection
Bilateral claim denied when modifier 50 is omitted or LT/RT not appended for ASC claims
Medical necessity denial when documentation lacks a qualifying neurological diagnosis or evidence of failed conservative treatment
Global period conflict: post-op E/M billed without modifier 24 is bundled and denied
Incorrect code selection: 27003 denied because coder used 27000 (percutaneous tenotomy only) or omitted the neurectomy component entirely

Frequently asked questions

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

01What's the difference between 27003 and 27000?

27000 is a percutaneous adductor tenotomy — no open incision, no nerve work. 27003 requires an open incision and adds obturator neurectomy. If the neurectomy wasn't performed, 27003 is not supported regardless of approach.

02Can 27003 be billed bilaterally?

Yes. When both hips are treated in the same session, use modifier 50 for physician billing. For ASC facility claims, bill two lines with LT and RT instead. Document both sides in the operative note.

03Does the 90-day global period apply to 27003?

Yes — 90-day global. All routine post-op care is bundled. Use modifier 24 on E/M services for unrelated conditions during the global window, and modifier 78 if the patient returns to the OR for a related complication.

04What ICD-10 diagnoses support medical necessity for 27003?

Spastic cerebral palsy (G80.1), spastic diplegia (G80.0), spastic hemiplegia (G80.2), and acquired spasticity codes (G81.1x, G82.1x) are the most common supporting diagnoses. The diagnosis must reflect a neurogenic etiology driving adductor spasticity.

05Is modifier 22 ever appropriate for 27003?

Yes, when the procedure is substantially more complex than typical — for example, revision after prior adductor surgery with significant scarring, or unusual patient size increasing operative difficulty. Attach a cover letter quantifying the additional time and complexity. Payers vary in whether they accept modifier 22 claims without appeal.

06Can 27003 and a hip injection or nerve block be billed on the same day?

Local anesthesia for the procedure itself is bundled and not separately billable. A separate and distinct therapeutic injection unrelated to surgical anesthesia may be reported with modifier 59 (or an X modifier) if clinically appropriate and documented as a distinct service — but this is uncommon in the same session.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the open approach, adductor tendon division, and obturator neurectomy as discrete documented steps from the surgeon's dictation — including laterality and the specific nerve work performed. This prevents downcoding to 27000 (percutaneous tenotomy only), which auditors select when the operative note is vague about the incision or omits the neurectomy entirely.

See how Mira captures CPT 27003 documentation