Decompression fasciotomy of one or more pelvic (buttock) compartments, including debridement, for acute compartment syndrome involving gluteal or iliopsoas musculature.

Verified May 8, 2026 · 6 sources ↓

Medicare: $920.86
Total RVUs: 27.57
Global, days: 90
Region: Hip

Drawn from CMSNIHBoa

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Documented clinical diagnosis of pelvic/buttock compartment syndrome, including mechanism (trauma, prolonged compression, vascular event, or post-surgical cause)
Intracompartmental pressure measurements or clinical findings justifying emergent decompression when pressure monitoring is performed
Operative note specifying which compartments were released by name (e.g., gluteus maximus, gluteus medius-minimus, iliopsoas, tensor fascia lata)
Description of the extent and nature of debridement performed, including tissue viability assessment and volume/type of necrotic tissue removed
Laterality clearly documented — left, right, or bilateral — in both the pre-op diagnosis and the operative note
Post-op plan addressing wound management (open vs. primary closure) and timeline for staged closure if applicable

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 58 Staged or related 59 Distinct service 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 27057 describes surgical decompression of the pelvic compartments — specifically the gluteus medius-minimus, gluteus maximus, iliopsoas, and/or tensor fascia lata — with debridement. It is the go-to code for acute compartment syndrome (ACS) of the buttock and pelvis, a limb- and life-threatening emergency that demands rapid fascial release to restore perfusion. The debridement component is bundled into the code; don't bill a separate debridement code for tissue removed as part of the decompression itself.

The 90-day global period means all routine post-op visits, wound checks, and staged closure visits are included unless a distinctly separate and unrelated E/M service is performed and documented. Staged wound closures following the fasciotomy — a common scenario given how frequently these wounds are left open initially — should be billed with modifier 58 (staged or related procedure during the global) if performed by the same surgeon. Unplanned returns to the OR for related complications fall under modifier 78. The procedure is inherently unilateral; bilateral fasciotomy would require modifier 50 with payer-specific claim-line 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	14.54
Practice expense RVU	9.94
Malpractice RVU	3.09
Total RVU	27.57
Medicare national rate	$920.86
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	$920.86
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI J8) Ambulatory surgical center (freestanding)	$1,179.92

Common denial reasons

The recurring reasons claims for CPT 27057 get rejected.

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

Missing or vague operative note — 'standard fasciotomy approach' without naming the specific compartments released triggers medical necessity review
Separate debridement code billed on the same date, which is bundled into 27057 and denied under NCCI edits
Staged wound closure billed without modifier 58 during the global period, denied as included in the global
Lack of documented intracompartmental pressures or insufficient clinical justification for emergent decompression when payer requires objective pressure data
Modifier 50 omitted when bilateral decompression is performed, resulting in payment for only one side or a claim-line edit rejection

Frequently asked questions

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

01Is debridement separately billable when performed with 27057?

No. Debridement is integral to the code descriptor and bundled by NCCI. Billing a separate debridement code on the same date will be denied.

02How do I bill staged wound closure after an open fasciotomy during the 90-day global?

Use modifier 58 to indicate a staged or related procedure during the global period. Document the staged closure as planned at the time of the original decompression to support the modifier.

03Can 27057 be billed bilaterally, and what's the claim-line rule?

Yes, if both sides are decompressed. Report with modifier 50 on a single claim line per CMS MCPM Chapter 12, Section 40.7.B. Some commercial payers instead require two lines with LT and RT — check payer-specific rules before submitting.

04What modifier applies if the same surgeon returns to the OR for a related complication within the 90-day global?

Modifier 78 covers an unplanned return to the OR for a complication directly related to the original procedure. Document that the return was unplanned and specify the complication in the operative note.

05Does 27057 require a specific ICD-10 diagnosis code to pass medical necessity review?

M79.3- (compartment syndrome) or trauma-specific codes with a documented ACS diagnosis are the expected primary diagnoses. Pelvic hematoma or post-surgical ACS should be coded as the underlying etiology with the compartment syndrome code sequenced appropriately. Vague pain or contusion diagnoses without compartment syndrome specificity commonly trigger denials.

06Is modifier 22 ever appropriate for 27057?

Yes, when the decompression is substantially more complex than typical — for example, extensive necrosis requiring prolonged debridement, morbid obesity creating significant anatomical difficulty, or multi-compartment involvement well beyond the standard case. Document increased operative time, complexity, and specific challenges in the operative note to support the upward modifier.

Sources & references

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

Mira AI Scribe

The Mira AI Scribe captures compartment identification by name, pressure measurements or clinical signs triggering decompression, tissues debrided with viability assessment, laterality, and wound closure status from surgeon dictation. This prevents the most common audit flag — operative notes that describe a generic 'fasciotomy' without specifying which pelvic compartments were entered — which routinely triggers medical necessity denials on post-pay audit.

See how Mira captures CPT 27057 documentation