Radical resection of a pelvic or hip tumor involving the ilium with acetabulum, both pubic rami, or the ischium with acetabulum — removing the tumor plus a margin of surrounding healthy bone and tissue.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $2,232.85
- Total RVUs
- 66.85
- 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 6 cited references ↓
- Imaging studies (MRI, CT, PET) confirming tumor location and extent of acetabular involvement
- Pathology or biopsy report establishing the diagnosis requiring radical resection
- Operative note specifying which pelvic structure was resected — ilium with acetabulum, both pubic rami, or ischium with acetabulum
- Documentation of wide-margin (radical) excision technique with notation of surrounding tissue removed
- Reconstruction method documented if performed — allograft, prosthesis, or other technique billed separately
- Pre-operative diagnosis linked to a matching ICD-10-CM code for primary or metastatic bone tumor of the pelvis
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 6 cited references ↓
CPT 27076 covers radical resection of bone tumors arising from major pelvic structures — specifically the ilium including the acetabulum, both pubic rami, or the ischium and acetabulum. 'Radical' here means wide-margin en bloc excision: the tumor comes out with a cuff of histologically normal tissue on all sides. This is not a simple curettage or marginal excision. The acetabular involvement is the defining anatomical criterion that separates 27076 from less extensive pelvic tumor codes.
The 90-day global period swallows all routine post-op care through day 90. Any E/M visit in that window billed for the same condition is bundled — no separate payment. Unrelated problems billed during the global need modifier 24; a separate significant E/M on the day of surgery needs modifier 25. Given the complexity of reconstruction that often follows this resection (custom implants, allograft, hip transposition), document each additional procedure separately with the correct code and modifier 51 or 62 as applicable.
Site of service matters here. HOPD and ASC payments differ substantially — see the Site of Service comparison on this page. Most payers require prior authorization for a procedure at this RVU weight; confirm auth is in place before the case, not after.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 39.2 |
| Practice expense RVU | 19.29 |
| Malpractice RVU | 8.36 |
| Total RVU | 66.85 |
| Medicare national rate | $2,232.85 |
| 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 | $2,232.85 |
HOPD (APC 5114) Hospital outpatient department | $7,413.38 |
ASC (PI G2) Ambulatory surgical center (freestanding) | $3,695.53 |
Common denial reasons
The recurring reasons claims for CPT 27076 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing or mismatched ICD-10-CM diagnosis — payer rejects if the tumor code doesn't map to a pelvic or acetabular site
- Lack of prior authorization — most commercial payers require auth for high-RVU oncologic resections
- Operative note describes curettage or marginal excision rather than radical wide-margin resection, undercutting medical necessity for 27076
- Unbundling flags when reconstruction codes are billed without modifier 51 or appropriate linkage to the primary procedure
- Global period violations — post-op E/M visits for the same condition billed without modifier 24 within the 90-day window
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What distinguishes CPT 27076 from other pelvic tumor excision codes?
02Can reconstruction be billed separately when performed at the same session?
03What modifiers are needed if a second surgery is required within the 90-day global?
04Is modifier 22 appropriate for 27076?
05Does site of service affect reimbursement for 27076?
06Which ICD-10-CM codes are typically linked to 27076?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02vsac.nlm.nih.govhttps://vsac.nlm.nih.gov/context/cs/codesystem/CPT/version/2024/code/27076/info
- 03gomedicalbilling.comhttps://gomedicalbilling.com/codes/cpt/27076
- 04cms.govhttps://www.cms.gov/files/document/08-chapter8-ncci-medicare-policy-manual-2026-final.pdf
- 05aapc.comhttps://www.aapc.com/codes/cpt-codes/27076
- 06emedny.orghttps://www.emedny.org/providermanuals/physician/pdfs/physician%20procedure%20codes%20sect5.pdf
Mira AI Scribe
Mira's AI scribe captures the specific pelvic structure resected (ilium with acetabulum, both pubic rami, or ischium with acetabulum), the surgical margin description, and any reconstruction performed — exactly what auditors check to validate 27076 over lower-level pelvic excision codes. That prevents downcoding denials and operative-note-insufficiency flags on post-payment review.
See how Mira captures CPT 27076 documentation