Surgical transfer of a tendon to the pelvis, typically to restore hip abductor or flexor function lost to neurologic injury, paralysis, or prior surgery.

Verified May 8, 2026 · 4 sources ↓

Medicare: $658.00
Work RVU: 9.09
Global, days: 90
Region: Hip

Drawn from CMSCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 4 cited references ↓

Diagnosis establishing muscle or neurologic deficit requiring tendon transfer (e.g., hip abductor paralysis, nerve palsy, polio sequela) with ICD-10 specificity
Operative note naming the specific donor tendon, detachment site, routing path, and fixation method at the pelvis — 'standard tendon transfer' is not sufficient
Pre-operative functional assessment documenting failed conservative management or prior surgical history justifying the transfer
Imaging or EMG/nerve conduction study results confirming the underlying deficit and absence of viable alternative
Laterality clearly documented in both the operative note and on the claim (LT or RT modifier required)

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 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 4 cited references ↓

CPT 27098 describes an open procedure in which a functioning tendon is rerouted and fixed to the pelvis to substitute for a paralyzed or absent muscle group — most commonly performed to address hip abductor weakness secondary to poliomyelitis, nerve palsy, or failed prior reconstruction. The donor tendon (frequently the iliopsoas) is detached from its native insertion, routed through a surgically created tunnel or over bony landmarks, and anchored to the pelvis with sutures, bone anchors, or through-bone fixation. The goal is to restore active hip stability and gait mechanics that passive reconstruction cannot achieve.

This is a 90-day global procedure. All routine post-op visits, wound checks, and suture removals through day 90 are bundled — bill separately only for unrelated E&M encounters (modifier 24) or new problems that require distinct decision-making (modifier 25). Because 27098 is a relatively low-volume code with no dominant billing specialty in CMS Provider Utilization data, payer familiarity varies; expect medical necessity review and have operative and pre-op imaging documentation organized before submission.

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 (9.09) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (19.7) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	9.09
Practice expense RVU	8.68
Malpractice RVU	1.93
Total RVU	19.7
Medicare national rate	$658.00
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	$658.00
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI J8) Ambulatory surgical center (freestanding)	$2,136.34

Common denial reasons

The recurring reasons claims for CPT 27098 get rejected.

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

Medical necessity not established — payer requires documented failed conservative or less-invasive treatment before approving open tendon transfer
Operative note lacks specificity on donor tendon identity and fixation technique, triggering audit or downcoding
Missing laterality modifier (LT/RT) causes automatic claim rejection or pend at many payers
Bundling conflict when additional soft-tissue or bony procedures billed same-day without a modifier 59 or XS to establish a separate and distinct service
Global period overlap — post-op E&M visits billed without modifier 24, causing denial as included services

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 4 cited references ↓

01Which tendon is most commonly transferred in a 27098 procedure?

The iliopsoas-to-greater-trochanter or iliopsoas-to-pelvis transfer is the classic indication, but any functioning donor tendon rerouted and fixed to the pelvis qualifies. Document the donor tendon by name in the operative note.

02Do I need a laterality modifier on 27098?

Yes. Append LT or RT on every claim. Most payers auto-pend or deny claims for unilateral procedures submitted without a side designator, and this is one of the most common clean-claim failures for musculoskeletal codes.

03Can I bill 27098 with another hip procedure on the same day?

Only if the second procedure is distinct and separately documented. Use modifier 51 for additional procedures under the same anesthetic, and modifier 59 or XS if NCCI bundling edits apply. Confirm the specific code pair in the NCCI PTP lookup before submitting.

04What does the 90-day global cover for 27098?

All routine post-op visits, wound care, suture or staple removal, and cast or splint checks through day 90 are bundled. Bill separately only for unrelated conditions (modifier 24) or distinct new problems requiring separate decision-making (modifier 25) during the global period.

05How do I handle a return to the OR for a complication within the 90-day global?

If the return procedure is related to the original surgery, use modifier 78. If it is an entirely unrelated procedure, use modifier 79. Do not invert these — using 79 for a related complication is incorrect and may result in overpayment recovery.

06Is prior authorization typically required for 27098?

Most commercial payers and Medicare Advantage plans require prior authorization for elective open tendon transfer procedures. Submit operative planning notes, the diagnosis with ICD-10 code, imaging, and documentation of conservative treatment failure at the time of the auth request to avoid delays.

Sources & references

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

Mira Scribe

Mira's AI scribe captures donor tendon identity, detachment site, routing path, fixation method, and pelvis attachment point directly from dictation. It flags operative notes that use generic language like 'tendon transferred to pelvis' without naming the specific tendon — the documentation gap most likely to trigger a payer audit or medical necessity denial on a low-volume code like 27098.

See how Mira captures CPT 27098 documentation