Surgical excision of a superficial bone cyst or benign tumor from the wing of the ilium, symphysis pubis, or greater trochanter of the femur; includes autograft harvest when performed.

Verified May 8, 2026 · 8 sources ↓

Medicare: $508.36
Total RVUs: 15.22
Global, days: 90
Region: Hip

Drawn from CMSMdclarityBedrockbillingEmednyAAPC

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Operative note must identify the exact anatomic site: wing of ilium, symphysis pubis, or greater trochanter of femur — not 'hip' generically.
Document lesion depth explicitly as superficial (above fascia) to distinguish from 27066 (subfascial).
If autograft is harvested, note whether it was obtained through the same incision (bundled) or a separate incision (use 27067 instead).
Preoperative imaging (X-ray, MRI, or CT) confirming lesion location and character should be referenced in the note.
Pathology report confirming benign or cystic diagnosis supports medical necessity and defends against upcoding to radical resection codes.
Record estimated lesion size and any intraoperative findings that required additional work if billing modifier 22 for increased complexity.

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 8 cited references ↓

27065 covers superficial excision of a bone cyst or benign tumor at one of three specific pelvic/proximal femur sites: the wing of the ilium, the symphysis pubis, or the greater trochanter of the femur. 'Superficial' here means above the fascia — if the lesion is subfascial, use 27066 instead. Autograft harvest from the same incision is bundled; a separate donor-site incision steps up to 27067.

The 90-day global period begins the day before surgery and runs through postoperative day 90. All routine follow-up, wound checks, and stitch removals in that window are included. Unrelated E/M services during the global need modifier 24; a related return to the OR needs modifier 78; an unrelated return to the OR needs modifier 79.

Site specificity drives ICD-10 selection and payer scrutiny. Diagnoses must map precisely to the operative site — ilium, pubis, or greater trochanter — not generically to 'hip.' Pathology confirming benign or cystic nature is expected in the record; a malignant or aggressive lesion shifts coding toward the radical resection codes (27075+).

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.39
Practice expense RVU	7.48
Malpractice RVU	1.35
Total RVU	15.22
Medicare national rate	$508.36
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	$508.36
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 27065 get rejected.

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

ICD-10 diagnosis code maps to a site not covered by 27065 (e.g., femoral shaft or acetabulum instead of greater trochanter, ilium, or pubis).
Depth documentation missing — payer cannot confirm superficial vs. subfascial, triggering a medical necessity denial or downcoding.
Autograft coded separately when harvested through the same incision — autograft via same incision is bundled into 27065.
Lesion pathology not documented prior to or following surgery, raising medical necessity questions for elective excision.
Modifier 50 billed without bilateral imaging or operative note confirming simultaneous bilateral procedure.

Frequently asked questions

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

01What's the difference between 27065, 27066, and 27067?

27065 is superficial (above fascia). 27066 is deep/subfascial. 27067 is used when autograft requires a separate donor-site incision regardless of depth. Use the depth documented in the operative note to pick between 27065 and 27066; don't default to 27065 when depth isn't specified.

02Is autograft harvest bundled into 27065?

Yes, when the graft is harvested through the same incision. If a separate incision is needed to obtain the autograft, use 27067 instead of 27065.

03Can 27065 be billed bilaterally?

Yes, if both hips are operated on in the same session. Append modifier 50 and document bilateral disease and bilateral operative findings. Some payers require LT and RT on separate lines instead — verify payer preference before submitting.

04What modifier applies if a related complication requires return to the OR during the 90-day global?

Modifier 78 covers an unplanned return to the OR for a procedure related to the original surgery during the global period. Modifier 79 is for an unrelated procedure. Don't invert these — inverting is a common audit flag.

05Does 27065 apply to a unicameral bone cyst on the femoral neck or shaft?

No. 27065 is restricted to the wing of the ilium, symphysis pubis, and greater trochanter. A cyst on the femoral neck or shaft requires a different code — AAPC forums point to other femur excision codes depending on exact location. Confirm anatomy before assigning 27065.

06Can modifier 22 be used with 27065?

Yes, when the procedure required substantially more work than typical — for example, an unusually large lesion, extensive bone loss requiring complex reconstruction, or difficult anatomy. Include a cover letter citing operative time, lesion size, and complexity. Payers will request documentation.

07What ICD-10 codes support 27065?

Diagnosis codes should map precisely to the operative site and lesion type — benign neoplasm of bone or bone cyst codes tied to the ilium, pubis, or femur (greater trochanter). A generic 'hip' neoplasm code without site specificity is a common denial trigger. Verify the ICD-10 code matches the exact anatomic site documented in the operative note.

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 operative site by name (wing of ilium, symphysis pubis, or greater trochanter), lesion depth relative to fascia, and whether autograft was obtained through the same or a separate incision. This prevents the most common 27065 denial — a vague 'hip' site description that fails to match an ICD-10 code tied to one of the three billable anatomic locations — and eliminates the autograft unbundling error before the claim is submitted.

See how Mira captures CPT 27065 documentation