Surgical denervation of the hip joint by cutting or ablating the intra-articular nerve branches of the sciatic, femoral, or obturator nerves, performed via an intrapelvic or extrapelvic approach to reduce arthritic hip pain.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,035.43
Total RVUs: 31
Global, days: 90
Region: Hip

Drawn from CMSNIHAAPC

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify whether the approach was intrapelvic, extrapelvic, or both — vague 'standard approach' language triggers audit flags.
Identify each nerve branch targeted: sciatic articular branches, femoral articular branches, obturator articular branches, or a combination.
Document the method of denervation (sharp transection, electrocautery, radiofrequency ablation if open) and confirm intra-articular branch localization.
Record the failure or contraindication of conservative and non-surgical pain management options to support medical necessity.
Note laterality explicitly (left, right, or bilateral) in both the operative note and the diagnosis linkage.
Include pre-operative imaging or diagnostic workup confirming hip joint pathology as the pain source.

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 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 6 cited references ↓

CPT 27035 describes surgical denervation of the hip joint targeting the intra-articular sensory branches of the sciatic, femoral, or obturator nerves — performed either intrapelvically or extrapelvically. The goal is interruption of nociceptive signaling at the joint level without disturbing motor function, typically in patients with end-stage hip arthritis who are not candidates for or who decline total hip arthroplasty. The procedure may address one or more nerve branches in a single session; the code is reported once per hip regardless of how many branches are treated.

This is a 90-day global procedure. All routine follow-up care through postoperative day 90 is bundled — bill unrelated E/M services with modifier 24, staged or planned secondary procedures with modifier 58, and unplanned returns for related complications with modifier 78. If an unrelated procedure is performed during the global period, use modifier 79. Bilateral performance at the same session is reported on a single line with modifier 50 for physician billing; ASC billing requires separate lines with modifiers LT and RT.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	16.94
Practice expense RVU	13.17
Malpractice RVU	0.89
Total RVU	31
Medicare national rate	$1,035.43
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	$1,035.43
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 27035 get rejected.

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

Medical necessity not established — no documented failure of conservative therapies or inadequate imaging supporting hip joint origin of pain.
Laterality mismatch between the operative note, claim, and ICD-10 diagnosis code.
Unbundling error: billing 27035 twice on the same date for the same hip when multiple nerve branches are treated — one unit covers all branches at that joint.
Missing or incorrect modifier when billed same-day with another surgical procedure or during a prior procedure's global period.
Procedure performed under a diagnosis with active coverage limitations or non-covered indications per the payer's LCD/NCD.

Frequently asked questions

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

01Can 27035 be billed twice if both the femoral and obturator articular branches are denervated in the same session?

No. 27035 is reported once per hip regardless of how many intra-articular nerve branches are treated. Billing two units for the same hip on the same date will be denied as a duplicate.

02How do you bill 27035 when performed bilaterally at the same operative session?

For physician billing, report one unit of 27035 with modifier 50. For ASC billing, report two lines — one with modifier LT and one with modifier RT — each at one unit of service, per NCCI ASC reporting requirements.

03What modifier applies if a patient returns within the 90-day global period with a new hip fracture requiring surgery?

Use modifier 79 — unrelated procedure during the global period. Modifier 78 is reserved for unplanned returns to treat a complication related to the original procedure. Inverting these is an audit flag.

04Is 27035 typically performed in an ASC or hospital outpatient setting, and does it affect payment?

Both settings are used. HOPD and ASC payments differ — see the Site of Service comparison on this page. Site selection should be documented based on patient acuity and expected anesthesia needs, not payment optimization.

05What ICD-10 diagnoses best support medical necessity for 27035?

Primary osteoarthritis of the hip (M16.x) is the most commonly linked diagnosis. Post-traumatic arthritis (M16.4/M16.5) and other specified hip arthropathies are also used. Confirm the payer's LCD — some require documented failure of at least three months of non-surgical treatment before approving denervation.

06Can modifier 22 be used if the denervation required unusually complex dissection due to prior hip surgery or significant scarring?

Yes, but only if the operative note explicitly describes the increased complexity — specific anatomic distortion, additional dissection time, and how it differed from a typical 27035. Generic statements about 'difficult anatomy' will not support modifier 22 on audit.

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 specific nerve branches targeted (sciatic, femoral, obturator articular branches), the surgical approach (intrapelvic vs. extrapelvic), the denervation method, and laterality directly from dictation. It also flags documentation of failed conservative treatment in the pre-op note. This prevents the two most common audit triggers for 27035: vague nerve identification and absent medical necessity narrative.

See how Mira captures CPT 27035 documentation