Open excision of the synovial membrane lining the hip joint, performed to reduce inflammation and restore function.

Verified May 8, 2026 · 7 sources ↓

Medicare: $651.32
Total RVUs: 19.5
Global, days: 90
Region: Hip

Drawn from CMSCgsmedicareAAPCFastrvuAAOS

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Preoperative diagnosis specifying the synovial pathology (e.g., inflammatory arthritis, PVNS) and why open excision was indicated over conservative or arthroscopic management
Operative note naming the surgical approach used to access the hip joint — vague references to 'standard approach' are an audit flag
Description of the extent of synovial membrane excision, including which compartments were addressed and the volume or distribution of diseased tissue
Concurrent procedures documented as performed at separate anatomic sites if billed separately, with clear anatomic distinction to support modifier 59 or XS if needed
Laterality documented explicitly (left or right hip) to support LT or RT modifier
Postoperative plan including weight-bearing status and rehabilitation timeline consistent with a 90-day global period

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 62 Co-surgeons 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 27054 describes an open hip synovectomy — the surgeon incises into the hip joint, explores the joint space, and excises the inflamed synovial membrane. The procedure is most commonly performed for inflammatory arthritis, pigmented villonodular synovitis (PVNS), or other synovial pathology unresponsive to conservative management.

This is an inpatient-only procedure under Medicare. CMS has designated 27054 with an inpatient-only status indicator, meaning it cannot be billed to Medicare in a hospital outpatient or ASC setting — only in the inpatient facility setting. The 90-day global period covers all routine postoperative care through day 90; any unrelated procedure within that window requires modifier 79, and any related return to the OR requires modifier 78.

Open debridement performed on the same hip joint during the same session is bundled per NCCI policy — a joint procedure includes debridement of that joint unless the debridement is performed on a distinctly separate joint. Document the specific structures excised, the extent of synovial involvement, and any concurrent procedures performed at separate anatomic sites to support separate billing where applicable.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	8.98
Practice expense RVU	8.61
Malpractice RVU	1.91
Total RVU	19.5
Medicare national rate	$651.32
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	$651.32
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI G2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 27054 get rejected.

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

Site-of-service mismatch — Medicare designates 27054 as inpatient-only; claims submitted under HOPD or ASC status indicators will deny
Bundling denial when open debridement of the same hip joint is billed separately on the same date without a valid NCCI modifier and supporting documentation
Missing or inconsistent laterality — claims submitted without LT or RT when payer requires side-specific billing are flagged for correction
Lack of medical necessity documentation — failure to document failed conservative treatment or clinical severity supporting open synovectomy over less invasive options
Global period conflict — postoperative E&M visits billed without modifier 24 when unrelated to the index procedure are denied within the 90-day global window

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Can CPT 27054 be performed and billed in an ASC or hospital outpatient setting under Medicare?

No. CMS designates 27054 as an inpatient-only procedure. Medicare will not reimburse this code in an ASC or HOPD setting — it must be performed and billed in the inpatient hospital setting.

02What modifier is required if the patient returns to the OR for a related complication during the 90-day global?

Use modifier 78 for an unplanned return to the operating room for a procedure related to the original surgery during the global period. Do not use modifier 79, which is reserved for unrelated procedures.

03Can open debridement of the same hip joint be billed separately on the same date as 27054?

No. Per NCCI policy, open procedures performed on a joint include debridement of that same joint. A separate debridement code is only reportable if the debridement is performed on a different joint, and modifier 59 or XS with supporting documentation would be required.

04Is modifier 50 appropriate for bilateral hip synovectomy performed in the same session?

Yes, modifier 50 applies if the procedure is performed on both hips during the same operative session. Alternatively, bill with LT and RT on separate lines per payer preference — confirm individual payer billing rules before submitting.

05What ICD-10 diagnoses most commonly support medical necessity for 27054?

Diagnoses tied to inflammatory synovial pathology — such as rheumatoid arthritis of the hip, pigmented villonodular synovitis, or other specified arthropathies — are the primary supporting diagnoses. The operative and clinical notes should link the confirmed diagnosis directly to the decision to perform open synovectomy.

06Can an E&M visit be billed on the same day as 27054?

Only if the E&M is significant, separately identifiable, and unrelated to the decision to perform the procedure — append modifier 25. The day-before visit is included in the global package for 90-day global procedures, so a pre-op visit within that window is not separately billable unless it clearly addresses a distinct problem.

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, the specific compartments of synovial membrane excised, the extent and distribution of synovial disease encountered, and any concurrent procedures performed at separate anatomic sites. This prevents the two most common audit flags for 27054: operative notes that reference only a 'standard approach' and bundling disputes where concurrent procedures lack clear anatomic separation in the record.

See how Mira captures CPT 27054 documentation