Surgical excision of a deep bone cyst or benign tumor from the wing of the ilium, symphysis pubis, or greater trochanter of the femur, at the subfascial level, with autograft bone grafting included when performed.

Verified May 8, 2026 · 6 sources ↓

Medicare: $758.53
Work RVU: 10.92
Global, days: 90
Region: Hip

Drawn from CMSNIHAAPCGenhealthHillphysicians

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify the exact anatomic site: wing of ilium, symphysis pubis, or greater trochanter of the femur — not just 'hip' or 'pelvis'.
Confirm subfascial depth explicitly in the operative note; superficial lesions belong under 27065.
Document whether autograft was harvested and used to fill the bone defect post-excision.
Include preoperative imaging (X-ray, MRI, or CT) confirming the lesion, its size, and its deep location.
Provide pathologic or histologic diagnosis supporting 'bone cyst or benign tumor' — required for ICD-10 matching and payer authorization.
If autograft donor site required a separate incision with significant additional work, document that distinctly in the operative report.

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 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 27066 covers deep (subfascial) open excision of a bone cyst or benign tumor arising from three specific anatomic sites: the wing of the ilium, the symphysis pubis, or the greater trochanter of the femur. The subfascial depth is what distinguishes this code from its superficial counterpart (27065) — the dissection goes beneath the fascia to reach the lesion. When the surgeon harvests autograft bone to fill the defect after excision, that work is bundled into 27066 and is not separately reportable.

The code sits within the pelvis and hip excision family alongside 27065 (superficial) and 27067 (which adds the acetabulum to the permissible sites). Choosing the wrong code in this family is a common audit trigger: document the anatomic site precisely and confirm subfascial depth in the operative note. If the lesion extends into or involves the acetabulum, 27067 is the correct code — not 27066 with modifier 22.

The 90-day global period applies. All routine post-op visits, wound checks, and stitch removals within 90 days are bundled. Any service unrelated to the excision billed in that window requires modifier 24 (E/M) or 79 (unrelated procedure). Prior authorization is required by most commercial payers — Hill Physicians and comparable managed care plans list 27066 as requiring authorization.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (10.92) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (22.71) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	10.92
Practice expense RVU	9.53
Malpractice RVU	2.26
Total RVU	22.71
Medicare national rate	$758.53
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	$758.53
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 27066 get rejected.

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

Wrong code in the family selected — 27065 billed when operative note confirms subfascial depth qualifying for 27066.
Acetabular involvement documented but 27066 billed instead of 27067, triggering payer downcoding.
Missing prior authorization — most commercial payers require it for this code; claims drop without it.
ICD-10 mismatch: pathology report finalizes a malignant diagnosis after a benign-coded claim is submitted.
Autograft separately billed with a bone graft code when it is already bundled into 27066.
Global period violation — post-op E/M visit billed without modifier 24 within the 90-day window.

Frequently asked questions

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

01What separates 27066 from 27065?

Depth. 27065 is for superficial lesions above the fascia. 27066 requires subfascial dissection. The operative note must explicitly confirm depth — auditors will downcode to 27065 if it doesn't.

02Is autograft bone grafting separately billable with 27066?

No. Autograft harvest and placement used to fill the excision defect is bundled into 27066. Billing a separate graft code will be denied as an NCCI bundle violation.

03When should 27067 be used instead of 27066?

When the lesion involves or extends into the acetabulum. 27067 adds the acetabulum to the permissible sites. Don't try to capture acetabular involvement with modifier 22 on 27066 — use the correct code.

04Does the 90-day global period affect billing for unrelated procedures?

Yes. Any unrelated surgical procedure performed within the 90-day global period requires modifier 79. An unrelated E/M visit requires modifier 24. Omitting these modifiers will result in claim denial or zero payment.

05Is prior authorization required for 27066?

Most commercial payers require it. Hill Physicians and similar managed care plans explicitly list 27066 as requiring authorization. Submit imaging, pathology, and clinical indication with the auth request to avoid delays.

06Can 27066 and 27140 be billed together on the same date?

NCCI edits bundle 27140 with 27130. If 27066 is also on the claim with 27130, expect denial on 27140 and scrutiny of the full claim. Review NCCI PTP edits before submitting any combination involving 27130.

07What ICD-10 codes are typically paired with 27066?

Benign bone tumors (D16.2–D16.9 depending on site) and bone cysts (M85.55–M85.59 for greater trochanter/pelvis region) are the standard pairings. The final pathology must support the benign diagnosis — a malignant result after surgery will require a corrected claim.

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 anatomic site (wing of ilium, symphysis pubis, or greater trochanter), confirms subfascial dissection depth, and flags autograft harvest and use — the three documentation elements most likely to trigger a downcode or denial. That prevents the single most common audit finding: an operative note that reads 'deep hip lesion excised' without site specificity or depth confirmation.

See how Mira captures CPT 27066 documentation