Surgical removal of a foreign body from the subcutaneous tissue of the pelvis or hip region.

Verified May 8, 2026 · 7 sources ↓

Medicare: $339.69
Work RVU: 1.87
Global, days: 10
Region: Hip

Drawn from CMSAbosCodingintelAAPCFindacode

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Explicit documentation of foreign body depth — subcutaneous, not subfascial or intramuscular — to justify 27086 over 27087
Nature, size, and type of foreign body identified and removed (e.g., metallic fragment, glass, organic material)
Description of surgical approach and confirmation of complete removal, including any imaging used intraoperatively
Operative note must state laterality (left vs. right hip or pelvis) to support LT/RT modifier assignment
Pre-op imaging or clinical findings supporting localization of the foreign body in the subcutaneous plane
Any complicating factors (e.g., prior infection, fragmentation, difficult localization) if modifier 22 is considered

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 25 Significant separate E/M 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 27086 covers open removal of a foreign object embedded in the subcutaneous tissue of the pelvis or hip. The critical distinction is depth: if the object is superficial to the fascia, 27086 applies. If it has migrated subfascially or into muscle, use 27087 instead. The physician determines depth intraoperatively, and that determination must be documented explicitly — not inferred.

Code selection also depends on anatomic specificity. Generic subcutaneous foreign body removal codes (10120, 10121) are used when no anatomic-site-specific code exists. For the pelvis and hip, 27086 is the designated anatomic code and takes precedence. Similarly, if the object is within muscle or a tendon sheath, 20520/20525 may apply, but 27086 controls when the foreign body is confirmed subcutaneous in this region.

The 10-day global period means routine follow-up through day 10 is bundled. If wound complications or retained fragments require a return visit outside normal post-op care, modifier 24 applies to an E/M; modifier 78 applies if the patient returns to the OR for a related unplanned procedure (e.g., wound debridement, retained fragment re-excision).

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 (1.87) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (10.17) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.87
Practice expense RVU	7.9
Malpractice RVU	0.4
Total RVU	10.17
Medicare national rate	$339.69
Global period	10 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	$339.69
HOPD (APC 5073) Hospital outpatient department	$2,967.63
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,248.36

Common denial reasons

The recurring reasons claims for CPT 27086 get rejected.

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

Depth not documented — payer downcodes to 10120 or denies 27086 when operative note lacks explicit subcutaneous vs. subfascial distinction
Wrong code selected — 27087 billed when depth documentation only supports subcutaneous removal, or vice versa
Missing or inconsistent laterality — claim lacks LT/RT modifier or modifier conflicts with ICD-10 laterality on the diagnosis code
ICD-10 mismatch — foreign body diagnosis code does not specify pelvis or hip location, creating CPT-to-diagnosis mismatch
Bundling with E/M on same date without modifier 25 on the evaluation and management service

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What's the difference between 27086 and 27087?

Depth. 27086 is for subcutaneous (above the fascia) foreign body removal. 27087 is for deep removal — subfascial or intramuscular. The surgeon determines depth intraoperatively, and the operative note must state it explicitly. Audit teams look for this distinction first.

02Can I bill 27086 instead of 10120 for a hip foreign body?

Yes. When an anatomic-site-specific code exists, it takes precedence over the generic integumentary codes 10120/10121. For subcutaneous foreign body removal in the pelvis or hip, 27086 is the correct code regardless of object size.

03Do I need modifier LT or RT on 27086?

Yes, always. Assign LT or RT based on laterality documented in the operative report. The ICD-10 diagnosis code must match. Mismatched laterality between the procedure and diagnosis codes is a straightforward denial.

04What global period applies to 27086, and what does it cover?

27086 carries a 10-day global. That includes the day of surgery and all routine post-op visits through day 10. Wound checks, dressing changes, and suture removal are bundled. An unrelated E/M in that window needs modifier 24.

05If the patient returns to the OR within the global because a fragment was retained, what modifier applies?

Modifier 78 — unplanned return to the OR for a complication related to the original procedure. Do not use modifier 79; that is for unrelated procedures. Document the retained fragment explicitly in the return operative note.

06When is modifier 22 appropriate for 27086?

When the removal required substantially increased work beyond typical — for example, a deeply embedded, fragmented, or previously infected foreign body requiring extended dissection or intraoperative imaging. Document time, complexity, and the specific factors that increased work. Without that documentation, payers reject modifier 22 routinely.

07Can 27086 and an E/M be billed on the same day?

Yes, if the E/M was a separately identifiable service beyond the decision to perform the procedure. Append modifier 25 to the E/M. Without modifier 25, the E/M bundles into 27086 under most payer edits.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures the foreign body type, precise anatomic location, and operative confirmation of subcutaneous depth from dictation — preventing the most common denial trigger for 27086, which is an operative note that fails to distinguish subcutaneous from subfascial removal. The scribe also flags laterality and prompts for intraoperative imaging notation when fluoroscopy or ultrasound was used.

See how Mira captures CPT 27086 documentation