Surgical decompression of the pelvic or gluteal fascial compartment, performed on a single side, to relieve pathologically elevated intracompartmental pressure.

Verified May 8, 2026 · 6 sources ↓

Medicare: $809.64
Work RVU: 12.71
Global, days: 90
Region: Hip

Drawn from CMSAAPCAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Intracompartmental pressure measurements or documented clinical findings (tense compartment, pain with passive stretch, paresthesias, pallor) that established the indication for fasciotomy
Operative note specifying the anatomical compartment(s) released (pelvic vs. gluteal), surgical approach, and confirmation of unilateral vs. bilateral procedure
Etiology of the compartment syndrome (trauma, prolonged positioning, crush injury, vascular event) with onset timeline documented in the history and physical
Pre- and post-procedure neurovascular assessment findings, including motor and sensory status of the affected extremity
If modifier 22 is appended, a separate written explanation of the substantially increased intraoperative complexity or time beyond the typical procedure

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 57 Decision for surgery 58 Staged or related 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27027 describes a fasciotomy of the pelvic or gluteal compartment — an open surgical release of the fascia encasing one side of the buttock or deep pelvic musculature to decompress a compartment syndrome. The procedure relieves pressure that, if left untreated, compromises perfusion and risks permanent neuromuscular damage. It is unilateral by definition; bilateral release requires modifier 50 or separate line-item reporting depending on payer policy.

The 90-day global period means all routine post-op care — wound checks, dressing changes, suture or staple removal, and related E/M visits — is bundled into the surgical payment through day 90. If a complication requires a return to the OR for a related procedure in that window, append modifier 78. For a distinct, unrelated surgical problem during the global, use modifier 79. A same-day E/M where the decision for this major surgery was made requires modifier 57 on the E/M code.

Compartment syndrome of the gluteal or pelvic region most often follows prolonged compression (e.g., positioning injury during surgery, crush trauma, or prolonged immobility), and correct ICD-10 diagnosis code selection is critical. Payers will scrutinize medical necessity tightly given the relative rarity of this presentation; the operative note must establish compartment pressure measurements or clinical signs that justified emergent or urgent fasciotomy.

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 (12.71) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (24.24) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	12.71
Practice expense RVU	8.9
Malpractice RVU	2.63
Total RVU	24.24
Medicare national rate	$809.64
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	$809.64
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI G2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 27027 get rejected.

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

Insufficient medical necessity documentation — payer requires compartment pressure values or objective clinical criteria not present in the operative note
Bilateral procedure billed as two units without modifier 50 or LT/RT laterality modifiers, triggering an MUE denial
E/M service billed same-day without modifier 57, causing the evaluation to bundle into the surgical global payment
ICD-10 diagnosis code mismatch — using a nonspecific or incorrect traumatic/non-traumatic compartment syndrome code that doesn't align with the documented clinical scenario
Return-to-OR wound management billed with modifier 79 instead of modifier 78 when the complication is directly related to the original compartment syndrome decompression

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Is 27027 always unilateral, and how do I bill if both sides are released?

27027 is inherently a unilateral code. If both gluteal or pelvic compartments are released in the same operative session, bill 27027 twice with modifier 50 (or with LT on one line and RT on the other, depending on your payer). Confirm your specific payer's bilateral billing preference before submitting, as some commercial plans require 50 on a single line while others want two lines.

02What ICD-10 codes pair with 27027?

Traumatic compartment syndrome of the hip, thigh, and buttock region (M79.A2x series) and non-traumatic compartment syndrome codes are the primary pairings. Select the code that matches the documented etiology — traumatic vs. non-traumatic — and confirm laterality coding where available. A mismatch between the ICD-10 and the operative indication is a frequent audit flag.

03Can I bill a same-day E/M with 27027?

Yes, but only with modifier 57 appended to the E/M code. Because 27027 carries a 90-day global, the day-of or day-before decision-for-surgery visit requires modifier 57 to be separately payable. Without it, the E/M bundles into the global and will be denied.

04What happens if the patient needs wound irrigation or secondary closure during the 90-day global?

If the return-to-OR procedure is directly related to the compartment syndrome or its decompression (e.g., wound debridement of the fasciotomy site), bill with modifier 78. Modifier 79 is only correct when the new procedure is entirely unrelated to the original surgery. Inverting these two modifiers is an audit trigger.

05Does site of service affect reimbursement for 27027?

Yes. HOPD and ASC facility payments differ significantly — see the Site of Service comparison on this page. The physician's professional fee also carries a site-of-service differential under the CMS Physician Fee Schedule 2026, with a lower non-facility RVU component when the procedure is performed in a facility setting versus an office.

06When is modifier 22 appropriate for 27027?

Append modifier 22 when documented intraoperative circumstances substantially increase the work beyond the typical fasciotomy — for example, severe adhesions from prior surgery, morbid obesity significantly complicating exposure, or an unusually extensive compartment necrosis requiring additional dissection. The operative note must narrate the specific factors that made the case atypical; a generic statement of 'increased difficulty' will not survive audit.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the documented trigger for fasciotomy — compartment pressure readings, clinical signs, and etiology — directly from dictation, along with laterality and the specific compartment(s) released. This prevents the most common denial for 27027: an operative note that confirms the procedure was performed but fails to establish the objective criteria that made it necessary.

See how Mira captures CPT 27027 documentation