Surgical removal of the femoral head with replacement by a prosthetic implant; the native acetabulum is left in place (hemiarthroplasty).
Verified May 8, 2026 · 7 sources ↓
- Medicare
- $1,035.76
- Total RVUs
- 31.01
- 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 7 cited references ↓
- Specify the implant type and manufacturer (unipolar vs. bipolar femoral head prosthesis) in the operative note.
- Document the indication — femoral neck fracture, avascular necrosis, or other pathology — with supporting imaging (X-ray or MRI).
- Record failed or contraindicated conservative treatment prior to surgical intervention.
- Note the surgical approach by name (posterior, anterolateral, direct anterior) — audit teams flag notes that say only 'standard approach'.
- Confirm acetabular cartilage was assessed and left intact; this distinguishes 27125 from 27130.
- Include pre-op functional status and ambulatory limitations to support medical necessity under applicable LCD criteria.
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 7 cited references ↓
27125 covers hemiarthroplasty of the hip — the femoral head is excised and replaced with a prosthetic component while the acetabular socket remains untouched. This distinguishes it from total hip arthroplasty (27130), where both sides of the joint are replaced. The procedure is most commonly performed for femoral neck fractures in elderly patients or for avascular necrosis where the acetabular cartilage is still viable.
27125 carries a 90-day global period. That window includes the day-before preoperative visit, the surgery itself, and all routine post-op management through day 90. Any E/M service for an unrelated condition during the global requires modifier 24; a separately identifiable E/M on the day of surgery requires modifier 25 appended to the E/M. Staged or unrelated procedures performed during the global need modifier 79.
Site of service matters here. HOPD and ASC payment rates differ substantially — see the Site of Service comparison table on this page. Most payers follow LCD guidance for major joint replacement (Novitas L36007, NGS L36039, WPS L39911, and others) requiring documented failure of conservative management, functional limitation, and imaging confirmation of the pathology. Bilateral hemiarthroplasty same-session is rare but reported with modifier 50; left or right laterality should always be specified with LT or RT.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 16.22 |
| Practice expense RVU | 11.36 |
| Malpractice RVU | 3.43 |
| Total RVU | 31.01 |
| Medicare national rate | $1,035.76 |
| 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 | $1,035.76 |
HOPD (APC 5115) Hospital outpatient department | $13,116.76 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $8,652.94 |
Common denial reasons
The recurring reasons claims for CPT 27125 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Miscoding as 27130 (total hip arthroplasty) when only the femoral component was replaced — payers audit implant invoices.
- Missing or insufficient medical necessity documentation; LCDs for major joint replacement require evidence of conservative treatment failure or acute fracture indication.
- Lack of laterality — claims without LT or RT modifiers are routinely rejected or pended by many Medicare contractors.
- Global period overlap: billing a related E/M or minor procedure within the 90-day window without the appropriate modifier (24, 78, or 79).
- ICD-10 mismatch — pairing 27125 with a diagnosis that maps more appropriately to total arthroplasty (e.g., severe bilateral OA) triggers medical necessity edits.
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 7 cited references ↓
01What is the difference between 27125 and 27130?
02Does 27125 require a modifier for laterality?
03What is the global period for 27125, and what does it include?
04Which ICD-10 codes pair with 27125 for Medicare medical necessity?
05Can 27125 and 27130 ever be billed together?
06Is modifier 22 ever appropriate for 27125?
07What LCD policies govern medical necessity for 27125?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/httpswwwcmsgovresearch-statistics-data-and-systemsmonitoring-programsmedicare-ffs-compliance/2a232-total-hip-arthroplasty-medical-necessity-and-documentation-requirements
- 03cms.govhttps://www.cms.gov/files/document/2025nccimedicarepolicymanualcompletepdf.pdf
- 04aapc.comhttps://www.aapc.com/codes/cpt-codes/27125
- 05mdclarity.comhttps://www.mdclarity.com/cpt-code/27125
- 06aahks.orghttps://www.aahks.org/practice-resources/coding-resource-center/
- 07aaos.orghttps://www.aaos.org/quality/coding-and-reimbursement/
Mira AI Scribe
The Mira AI Scribe captures the surgical approach by name, implant details (unipolar vs. bipolar, manufacturer), acetabular status, and the primary indication (fracture type, AVN stage, or other pathology) directly from surgeon dictation. That prevents the most common audit flag on 27125: an operative note that doesn't clearly differentiate hemiarthroplasty from total hip arthroplasty, or one that omits implant specifics that payers cross-reference against invoice data.
See how Mira captures CPT 27125 documentation