Radical resection of a tumor involving a wing of the ilium, one pubic or ischial ramus, or the symphysis pubis, with removal of a margin of surrounding healthy tissue.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $1,858.43
- Total RVUs
- 55.64
- Global, days
- 90
- Region
- Hip
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 5 cited references ↓
- Operative note must name the specific anatomic structure resected (iliac wing, pubic ramus, ischial ramus, or symphysis pubis) — 'pelvic tumor excision' alone is insufficient.
- Document the radical nature of the resection: explicit description of tumor margins removed and width of normal tissue excised on each side.
- Pre-operative imaging (CT, MRI, or PET) confirming tumor location, size, and extent within the named pelvic structure.
- Pathology report confirming the specimen submitted, ideally with margin status — auditors cross-reference the operative note to the path report.
- If modifier 22 is appended, include a separate summary letter documenting increased operative time, unusual tumor extent, or anatomic complexity that distinguishes the case from a typical 27075.
- ICD-10 diagnosis must specify the tumor type and site; a mismatch between diagnosis code (benign vs. malignant vs. uncertain behavior) and the clinical record is a common claim flag.
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 5 cited references ↓
CPT 27075 covers radical resection of a pelvic/hip tumor — specifically a wing of the ilium, a single pubic or ischial ramus, or the symphysis pubis. Radical resection means the surgeon removes the tumor plus a cuff of normal tissue on all sides; this is not a simple excision or curettage. The code sits in the Excision Procedures on the Pelvis and Hip Joint family and carries a 90-day global period.
The 90-day global covers the day-before visit, the surgery itself, and all routine post-op management through day 90. Separate E/M visits within that window require modifier 24 (unrelated) or 25 (same-day, separate problem). Staged or planned return procedures within the global need modifier 58; unplanned returns for a related complication use modifier 78; unrelated procedures in the global use modifier 79.
Because this is an extensive oncologic resection, modifier 22 is defensible when operative time or complexity significantly exceeds the typical case — but attach a cover letter with the operative note summarizing what drove the increased work. Site-of-service matters: HOPD and ASC payments differ materially (see the Site of Service comparison table on this page). Most payers require pathology-confirmed diagnosis and pre-operative imaging for prior 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 | 31.89 |
| Practice expense RVU | 16.96 |
| Malpractice RVU | 6.79 |
| Total RVU | 55.64 |
| Medicare national rate | $1,858.43 |
| 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 | $1,858.43 |
HOPD (APC 5114) Hospital outpatient department | $7,413.38 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $4,682.29 |
Common denial reasons
The recurring reasons claims for CPT 27075 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Diagnosis code does not support radical resection — benign lesion diagnosis submitted without documentation of aggressive local behavior or surgeon rationale for radical margins.
- Operative note describes a simple excision or curettage rather than a true radical resection with surrounding normal-tissue margins, causing downcoding or denial.
- Missing prior authorization: most commercial payers and Medicare Advantage plans require pre-auth for pelvic tumor resections at this RVU level.
- Site-of-service mismatch: claim billed to HOPD rate but facility submitted as freestanding ASC, or vice versa, triggering payment reconciliation.
- Unbundling of biopsy performed at the same session without appropriate modifier — a biopsy integral to the resection is not separately reportable.
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01What distinguishes 27075 from a lesser hip tumor excision code?
02Can 27075 be billed with a same-day biopsy?
03When is modifier 22 appropriate for 27075?
04Does the 90-day global period affect post-op oncology visits?
05Is 27075 performed bilaterally?
06What ICD-10 codes typically support 27075?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02aapc.comhttps://www.aapc.com/codes/cpt-codes/27075
- 03cms.govhttps://www.cms.gov/files/document/04-chapter4-ncci-medicare-policy-manual-2026-final.pdf
- 04findacode.comhttps://www.findacode.com/cpt/27075-cpt-code.html
- 05mdclarity.comhttps://www.mdclarity.com/cpt-code/27075
Mira AI Scribe
Mira's AI scribe captures the specific anatomic structure resected (iliac wing, pubic ramus, ischial ramus, or symphysis pubis), the extent of normal-tissue margins taken on each side, estimated blood loss, and operative time directly from surgeon dictation. That structured capture prevents the most common audit flag for 27075 — an operative note that documents tumor removal without describing the radical margin, which auditors use to downcode to a lesser excision.
See how Mira captures CPT 27075 documentation