Surgical · Hip

Open surgical incision into the hip joint to drain infectious fluid or pus, with exploration and irrigation of the joint space.

Verified May 8, 2026 · 6 sources ↓

Medicare: $860.74
Total RVUs: 25.77
Global, days: 90
Region: Hip

Drawn from CMSCgsmedicareAAPCGenhealthEmedny

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Named surgical approach (e.g., anterolateral, posterior) — notes that say 'standard approach' are audit targets
Confirmation that the joint capsule was entered and arthrotomy was performed, not just a periarticular drain
Volume and character of fluid drained (purulent, serosanguineous, quantity in mL)
Documentation of intraoperative culture specimens collected and submitted
Irrigation method and solution used during joint lavage
Pre-op diagnosis supporting joint infection or pathologic effusion (ICD-10 code must match — e.g., M00.851 for staphylococcal arthritis of right hip)
Any implant status if procedure is performed in a hip with prior arthroplasty hardware, relevant for DRG and modifier decisions

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 52 Reduced services LT Left side RT Right side 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27030 describes an open arthrotomy of the hip performed to drain pathologic fluid — most commonly purulent material from septic arthritis. The surgeon incises through soft tissue and the joint capsule, evacuates the fluid, irrigates the joint, and closes in layers. Intraoperative cultures are typically collected. This is a distinct open procedure; it is not a needle aspiration and is not the same as hip arthroscopy with irrigation (29871 covers the knee equivalent; no direct hip arthroscopic drainage code exists, making 27030 the go-to for open hip joint sepsis management).

The 90-day global period covers the operative day, the day-before visit, and all routine post-op management through day 90. Any E/M visit during the global for a problem unrelated to the hip infection requires modifier 24. A planned staged return to the OR for the same infection (e.g., repeat washout) bills with modifier 78. An unrelated procedure during the global period uses modifier 79. Distinguish 27030 from 26990 (incision and drainage of deep abscess or hematoma in the pelvis/hip area) — 26990 does not enter the joint capsule; 27030 does.

Site of service matters. The procedure is almost exclusively performed in a hospital OR under general or regional anesthesia, consistent with the HOPD rate being nearly double the ASC rate. If performed in an ASC, bill LT or RT on separate claim lines for bilateral cases rather than a single line with modifier 50, per NCCI ASC billing rules.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	13.31
Practice expense RVU	9.64
Malpractice RVU	2.82
Total RVU	25.77
Medicare national rate	$860.74
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	$860.74
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 27030 get rejected.

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

ICD-10 mismatch — diagnosis code does not support an infectious or pathologic joint process requiring open drainage
Unbundling conflict when 26990 (periarticular I&D) is billed same day — payer treats it as duplicate without modifier and documentation showing separate anatomic sites
Missing modifier 78 when procedure is a return to OR during the global period of a prior hip surgery — claim denies as included in global
Lack of documentation confirming entry into the joint capsule, causing downcoding to 26990 or outright denial
Bilateral billing on a single claim line without modifiers LT/RT in ASC settings, triggering NCCI edits

Frequently asked questions

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

01What is the difference between CPT 27030 and CPT 26990?

26990 covers incision and drainage of a deep abscess or hematoma in the pelvis or hip area without entering the joint capsule. 27030 requires opening the joint itself — the arthrotomy. If your operative note doesn't confirm capsulotomy and intra-articular access, expect downcoding to 26990.

02Can I bill 27030 for a repeat hip washout during the global period of the first washout?

Yes, with modifier 78. A planned or unplanned return to the OR for a related procedure (repeat irrigation and drainage of the same joint infection) during the 90-day global uses modifier 78. Payment is reduced to the intraoperative component RVUs only — the pre- and post-op work is already captured in the first procedure's global.

03Is 27030 ever appropriate when a total hip replacement is already in place?

Yes. Periprosthetic joint infection requiring open joint washout is still coded 27030 if the procedure is limited to drainage and irrigation without component exchange. If the surgeon exchanges components (liner, head, or both), additional codes apply and modifier 22 may be warranted for the increased complexity.

04How should bilateral hip drainage be billed?

In the physician office or hospital setting, bill a single line with modifier 50. In an ASC, bill two separate claim lines using modifier LT on one and RT on the other, each with one unit of service, per NCCI ASC billing rules.

05Does 27030 cover the cost of intraoperative cultures?

The arthrotomy itself does not bundle culture collection codes — laboratory processing codes are separately billable by the performing lab. However, collection of the specimen is considered part of the surgical service and is not separately reported by the surgeon.

06What modifier is needed for a same-day E/M visit when the surgeon decides intraoperatively to proceed with 27030 after a clinic evaluation?

Use modifier 57 on the E/M if the decision to perform this major surgery (90-day global) was made at that visit. If the visit was for a separate, unrelated problem, use modifier 25 instead. The distinction matters: 57 applies when the visit drives the surgical decision for a major procedure.

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 surgical approach by name, confirms capsulotomy and joint entry in the dictation, records fluid character and volume, notes culture collection, and documents the irrigation technique — all from the surgeon's verbal dictation. This prevents the most common audit flag: operative notes that describe a periarticular drain without explicitly confirming intra-articular access, which risks downcoding to 26990 and a significant reimbursement loss.

See how Mira captures CPT 27030 documentation