Open hip capsulectomy or capsulotomy, with or without heterotopic bone excision and release of hip flexor muscles including gluteus medius, gluteus minimus, and iliopsoas.

Verified May 8, 2026 · 8 sources ↓

Medicare: $942.91
Total RVUs: 28.23
Global, days: 90
Region: Hip

Drawn from CMSFastrvuPayerpriceBedrockbillingCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Specify whether procedure was capsulectomy, capsulotomy, or both — and whether it was partial or complete
Identify the surgical approach by name (e.g., anterolateral, posterior, direct anterior)
Name each hip flexor muscle released (e.g., iliopsoas, gluteus medius, gluteus minimus) if muscle release was performed
Document heterotopic ossification location, extent, and Brooker grade if applicable and if HO excision was performed
Confirm open (not arthroscopic) technique — arthroscopic capsular work codes differently
Record preoperative range-of-motion deficits and functional limitations that establish medical necessity
Include imaging (X-ray, CT) correlating to intraoperative findings, particularly for HO cases

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 58 Staged or related 59 Distinct service 62 Co-surgeons 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 8 cited references ↓

27036 covers an open surgical procedure on the hip joint capsule — either partial or complete excision (capsulectomy) or incision and release (capsulotomy). The procedure frequently includes excision of heterotopic ossification around the hip and release of tight hip flexor muscles such as the gluteus medius, gluteus minimus, and iliopsoas. It is performed when severe capsular contracture, post-traumatic stiffness, or heterotopic bone formation has restricted hip range of motion to a functionally limiting degree.

This is an open procedure — not arthroscopic. If your surgeon performed arthroscopic capsular work, that routes to a different code family. 27036 carries a 90-day global period, meaning all routine post-op visits, wound checks, and related management from the day before surgery through day 90 are bundled. Any unrelated evaluation or new problem addressed in that window requires modifier 24 or 25.

Heterotopic ossification (HO) excision is the most common clinical driver for this code. Document the HO location, Brooker classification if used, and whether muscle release was performed — auditors expect specificity on which muscles were released and confirmation that the approach was open. Operative notes that describe the procedure generically without naming muscles or approach type are a known audit trigger.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	14.02
Practice expense RVU	11.24
Malpractice RVU	2.97
Total RVU	28.23
Medicare national rate	$942.91
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	$942.91
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 27036 get rejected.

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

Medical necessity not established — preoperative documentation lacks objective ROM measurements or functional deficit description
Operative note uses generic language ('standard approach,' 'capsule released') without naming muscles or approach, triggering audit or downcoding
Bundling conflict when a separately billed component procedure is considered inclusive to 27036 under NCCI edits without a valid modifier
Procedure coded as arthroscopic hip capsule work, which doesn't map to 27036 — causing mismatch between op note and code
Global period violation — post-op visits billed without modifier 24 when a new problem is addressed within the 90-day global

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01Does 27036 include heterotopic ossification excision, or is that billed separately?

HO excision is included in 27036 when performed at the hip capsule during the same operative session. The code descriptor explicitly covers the procedure with or without heterotopic bone excision — bill it once and document the HO extent in the operative note.

02Can 27036 be billed for arthroscopic hip capsule work?

No. 27036 is an open procedure. Arthroscopic hip capsular procedures map to a different code family. Billing 27036 for arthroscopic work creates a documentation-to-code mismatch that auditors and payers will catch.

03What is the global period for 27036, and what does it bundle?

27036 carries a 90-day global period. That includes the day-before surgery visit, the procedure itself, and all routine post-op care through day 90. Unrelated E/M visits in that window need modifier 24; unrelated procedures need modifier 79.

04How should bilateral hip capsulectomies be billed?

For professional claims, report 27036 with modifier 50 on a single line. ASCs report two separate lines using LT and RT. Confirm payer preference — some commercial payers deviate from the standard Medicare bilateral billing convention.

05Can 27036 be billed same-day with a total hip arthroplasty?

Rarely, and only with strong documentation. Capsulectomy is frequently considered integral to THA. If the capsulectomy is a distinct, separately documented procedure performed at a different surgical stage or for a different clinical purpose, modifier 59 or XS may apply — but expect scrutiny and confirm NCCI edit status before billing.

06Is modifier 22 appropriate when the hip capsulectomy involves extensive heterotopic bone requiring significantly increased surgical time?

Yes, modifier 22 is appropriate when the procedure is substantially more complex than typical — for example, extensive Brooker grade III or IV HO requiring prolonged dissection. You need an operative note that quantifies the increased time and complexity, and a cover letter explaining the basis for the modifier when submitting.

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, each muscle released, whether the capsule was fully or partially excised, and the presence and extent of heterotopic ossification from the surgeon's dictation. It flags operative notes that omit approach specificity or muscle-level detail — the documentation gaps most likely to draw an audit or support a medical necessity denial.

See how Mira captures CPT 27036 documentation