Surgical removal of a hip joint prosthesis performed as a distinct, standalone procedure — not incidental to a concurrent revision or reimplantation.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $773.23
- Total RVUs
- 23.15
- 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 ↓
- Specify which component(s) were removed (femoral stem, acetabular cup, femoral head) and confirm no immediate reimplantation occurred at the same session.
- State whether the prosthesis was cemented or cementless — cement removal steers the case toward 27091, not 27090.
- Document the clinical indication driving explantation: infection, aseptic loosening, fracture, component failure, staged exchange protocol, or resection arthroplasty.
- Record whether an antibiotic spacer or any other device was inserted after removal — spacer placement means 27091 applies.
- Include intraoperative findings: bone stock quality, evidence of osteolysis, periprosthetic membrane, and any cultures sent, which support medical necessity.
- Note the surgical approach by name and confirm no concurrent hip revision or reconstruction code was billed at the same session, or document why an unbundled code applies.
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 ↓
27090 covers removal of a hip prosthesis when that explantation is the primary surgical objective and stands alone — it is designated a 'separate procedure,' meaning it is bundled into any same-session hip revision or replacement code if a new implant or spacer is placed at the same time. When removal is the terminal event (staged explantation before delayed reimplantation, resection arthroplasty, or infection control without immediate reconstruction), 27090 is the correct code.
The boundary between 27090 and 27091 is complexity. 27091 applies when removal involves a total hip prosthesis, cement (methylmethacrylate) removal, or spacer insertion — a materially more demanding procedure. Use 27090 for straightforward single-component removals without cement or spacer work. If your operative note describes cemented components, extensive bone loss requiring grafting, or antibiotic spacer placement, 27091 is almost certainly the right code — and auditors will check.
Carries a 90-day global period under CMS. All routine post-op care, wound checks, and stitch removal through day 90 are bundled. If you see the patient for an unrelated problem during that window, append modifier 24 to the E/M. If you make the decision for surgery at an E/M visit the day before or day of, append modifier 57 to that visit. CMS designates this as an inpatient-only procedure (status indicator C on OPPS); it is not on the ASC Covered Procedures List.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 11.4 |
| Practice expense RVU | 9.36 |
| Malpractice RVU | 2.39 |
| Total RVU | 23.15 |
| Medicare national rate | $773.23 |
| 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 | $773.23 |
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 27090 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Bundled into same-session revision: payers deny 27090 when a revision code (27134, 27137, 27138) is billed the same day, because removal is inherent to revision surgery.
- Upcoded to 27091 without documentation: claims billed as 27090 that describe cement removal or spacer insertion are flagged; the reverse — 27090 billed when the note describes a total hip with methylmethacrylate — is denied or downcoded.
- Missing medical necessity: explantation without a supported ICD-10 diagnosis (infection, periprosthetic fracture, aseptic loosening, mechanical failure) triggers payer review and denial.
- Site-of-service mismatch: 27090 is an inpatient-only procedure under OPPS; billing it for an outpatient facility or ASC setting will be denied by Medicare.
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01When does 27090 get bundled into a revision code and when does it stand alone?
02What is the line between 27090 and 27091?
03Can modifier 22 be appended to 27090 for a difficult removal?
04Is 27090 billable in an ASC or outpatient hospital?
05How does the 90-day global period affect billing around 27090?
06What ICD-10 diagnoses most commonly support 27090?
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/27090
- 03aapc.comhttps://www.aapc.com/codes/coding-newsletters/my-orthopedic-coding-alert/got-a-hip-replacement-know-what-services-are-bundled-109374-article
- 04zimmerbiomet.comhttps://www.zimmerbiomet.com/content/dam/zb-corporate/en/support/coding-guides/0772.7-US-en%20Hip%20Systems%20Coding%20Reference%20Guide.pdf
- 05aaos.orghttps://www.aaos.org/globalassets/quality-and-practice-resources/coding-and-reimbursement/resident-guide/resident-guide_modifiers.pdf
- 06cms.govhttps://www.cms.gov/medicare/coding-billing/ncci-medicaid/medicaid-ncci-policy-manual
Mira AI Scribe
Mira's AI scribe captures the removed component(s) by name, fixation method (cemented vs. cementless), disposition after removal (no reimplantation, spacer placed, resection arthroplasty), and the driving clinical indication from dictation. This prevents the most common audit flag on 27090: an operative note that describes cement removal or spacer insertion but bills the simpler removal code — or vice versa — triggering a 27090-vs-27091 discrepancy review.
See how Mira captures CPT 27090 documentation