Radical resection of a tumor or infection involving the total innominate bone (ilium, ischium, and pubis as a composite structure), with wide excision margins extending into surrounding healthy tissue.

Verified May 8, 2026 · 6 sources ↓

Medicare: $2,483.02
Total RVUs: 74.34
Global, days: 90
Region: Hip

Drawn from CMSAAPCAcgmePayerprice

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Pathology or biopsy report confirming diagnosis (tumor or infection) involving the innominate bone
Operative note naming the specific bones resected (ilium, ischium, pubis) and confirming total innominate bone involvement — partial resections map to 27075 or 27076
Margin documentation: describe the extent of healthy tissue excised beyond the lesion boundary
Reconstruction method documented if applicable — required to support any add-on codes such as 20932
Pre-authorization reference number and supporting imaging (MRI/CT staging) tied to the claim
Surgeon attestation of primary vs. co-surgeon role if modifier 62 is appended

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 58 Staged or related 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27077 describes radical resection of the innominate bone in its entirety — the fused complex of ilium, ischium, and pubis — performed for tumor or infection requiring wide-margin excision. This is one of the most technically demanding pelvic oncologic procedures in orthopedic surgery, distinguished from limited resections (27075, 27076) by its total innominate bone involvement. The operative field typically encompasses the acetabulum and surrounding soft tissue, and reconstruction decisions significantly affect operative complexity and add-on coding.

The 90-day global period means all routine post-op care through day 90 is bundled. Staged reconstructive procedures within that window require modifier 58. Unplanned returns for related complications bill under modifier 78; unrelated procedures in the same global period use modifier 79. Add-on code 20932 (allograft, structural, for implantation) lists 27075–27077 as eligible base codes per CPT code-first instructions — confirm documentation supports the allograft use before appending.

This code sits in the ACGME musculoskeletal oncology case log under the Spine/Pelvis defined category, reflecting its specialized fellowship-level complexity. Payer authorization requirements are uniformly strict: expect pre-authorization with pathology or biopsy confirmation, surgical plan documentation, and occasionally tumor board attestation before the claim is even submitted.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	44.08
Practice expense RVU	20.85
Malpractice RVU	9.41
Total RVU	74.34
Medicare national rate	$2,483.02
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	$2,483.02
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 27077 get rejected.

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

Upcoding flag: payer downcodes to 27075 or 27076 when operative note describes partial rather than total innominate bone resection
Missing prior authorization — virtually all commercial payers and Medicare Advantage plans require pre-auth for this high-RVU oncologic procedure
Unbundling denial when 20932 is appended without documentation specifying structural allograft implantation as a distinct service
Global period conflict: post-op evaluation claims submitted without modifier 24 when billed within the 90-day window
Modifier 62 co-surgeon denial due to missing operative reports from both surgeons or failure to document distinct portions of the procedure

Frequently asked questions

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

01What separates 27077 from 27075 and 27076?

27075 covers resection of a single pelvic component (wing of ilium, one pubic or ischial ramus, or symphysis pubis). 27076 covers the ilium including acetabulum, both pubic rami, or ischium with acetabulum. 27077 is the total innominate bone — all three fused components. The operative note must be explicit about extent of resection or payers will downcode.

02Can 20932 be billed with 27077?

Yes. CPT code-first instructions for 20932 (structural allograft for implantation) list 27075–27077 as eligible primary codes. Document the allograft type, source, and implantation method in the operative note to support the add-on.

03How does modifier 62 apply here?

Modifier 62 is appropriate when two surgeons of different specialties (e.g., orthopedic oncology and general/vascular surgery) each perform distinct, documented portions of the resection. Both surgeons must submit separate operative reports describing their individual work. Payers routinely request both notes before paying either claim.

04What triggers modifier 22 for this code?

Modifier 22 is defensible when operative time and complexity significantly exceed typical radical pelvic resection — for example, extensive vascular involvement, prior radiation field, or massive soft tissue contamination from infection. Document total operative time, complications encountered, and the specific factors increasing difficulty.

05Is 27077 performed in an ASC?

Rarely. CMS does list an ASC payment rate for 27077, but the procedure's complexity, blood loss risk, and post-op monitoring requirements make inpatient hospital (place of service 21) the standard setting. Expect payer scrutiny if billed in an ASC without supporting clinical justification.

06What ICD-10 codes are typically paired with 27077?

Primary bone malignancies (C41.4 — malignant neoplasm of pelvic bones) and metastatic disease to pelvic bone (C79.51) are the most common diagnoses. Chronic osteomyelitis of the pelvis (M86.659) covers the infection indication. The diagnosis must be confirmed by pathology or imaging before the claim is submitted.

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 specific bones resected (ilium, ischium, pubis), confirms total versus partial innominate bone involvement, documents margin extent, and flags the reconstruction method from dictation. This prevents the most common denial trigger — a vague operative note that gives auditors grounds to downcode to 27075 or 27076.

See how Mira captures CPT 27077 documentation