Primary total hip arthroplasty replacing both the acetabular socket and proximal femoral components with prosthetic implants, with or without bone graft.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,162.02
Total RVUs: 34.79
Global, days: 90
Region: Hip

Drawn from CMSZimmerbiometAAHKS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirmation this is a primary (first-time) THA — no prior prosthetic component in this hip joint
Duration and severity of hip pain with functional limitations documented in the history
Physical exam findings: range-of-motion deficits, antalgic gait, joint-line tenderness
Imaging (X-ray minimum) confirming articular degeneration or structural pathology warranting total replacement
Record of failed conservative treatment (physical therapy, injections, NSAIDs) — required by MAC LCDs for medical necessity
Operative note identifying both acetabular and femoral components placed, implant manufacturer and lot numbers, and whether bone graft was used and of what type
Laterality clearly documented in both the operative note and the billing record to support LT/RT modifier

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 57 Decision for surgery 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

Related ICD-10 diagnoses

Diagnoses commonly reported with CPT 27130.

Source · CMS LCDs · AAOS specialty guidance · claims-pattern analysis

M16.11 M16.12 M16.0 M87.051

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27130 covers a first-time, primary total hip arthroplasty — simultaneous replacement of the acetabular and proximal femoral components with prosthetic hardware. Bone graft (autograft or allograft) may be used and does not change the code. Use 27130 only when neither component has been previously replaced. If the hip had any prior surgery that is now being converted to a full THA, use 27132 instead. Revision of an existing THA — whether one or both components — falls under 27134, 27137, or 27138. Mixing these codes is the most flagged error in hip arthroplasty audits.

27130 carries a 90-day global period. That window covers the day-before visit, the surgery itself, and all routine post-op care through day 90 — dressing changes, suture removal, and standard follow-up. Services unrelated to the THA billed during the global period require modifier 79. An unplanned return to the OR for a complication related to the original THA requires modifier 78. For a same-day E/M that drives the surgical decision, append modifier 57 to the E/M.

27130 is eligible for outpatient (HOPD) and ASC settings under Medicare — it carries OPPS status indicator J1 (comprehensive APC 5115) in the hospital outpatient setting and payment indicator J8 in the ASC setting, meaning implant costs factor into the adjusted rate. Always append LT or RT to identify the operative side; bilateral same-session THA uses modifier 50. Document failed conservative management — MACs across jurisdictions require evidence that non-operative care was attempted and insufficient before approving coverage.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	19.11
Practice expense RVU	11.63
Malpractice RVU	4.05
Total RVU	34.79
Medicare national rate	$1,162.02
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	$1,162.02
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$9,614.11

Common denial reasons

The recurring reasons claims for CPT 27130 get rejected.

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

Wrong code selected — 27130 billed when prior hip surgery makes 27132 (conversion) the correct code
Missing or insufficient documentation of failed conservative treatment — MACs deny without evidence of non-operative management
Lack of imaging in the medical record to corroborate severity of joint degeneration
Laterality modifier (LT or RT) absent, triggering claim suspension or rejection
Routine post-op services billed separately inside the 90-day global without appropriate modifier 24 or 79
Medical necessity not established — operative note does not connect clinical findings to functional impairment

Frequently asked questions

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

01Can 27130 be billed when bone graft is used?

Yes. The code descriptor explicitly includes 'with or without autograft or allograft.' Bone graft use does not change the code and does not justify a separate graft code for the same surgical site.

02What code applies if the patient had a prior hemiarthroplasty and is now getting a full THA?

Use 27132 (conversion of previous hip surgery to THA), not 27130. Prior hardware in the hip — even a partial replacement — moves the procedure out of the primary code family. Billing 27130 in this scenario is a common audit finding.

03Is 27130 covered in an ASC setting under Medicare?

Yes. CMS added THA to the ASC covered procedures list. It carries payment indicator J8 (device-intensive, paid at adjusted rate). Confirm your ASC is contracted and credentialed appropriately, as some commercial payers still restrict site of service.

04What modifier applies if the surgeon returns the patient to the OR during the global period for a related complication?

Modifier 78 — unplanned return to the OR for a procedure related to the original THA. Do not use modifier 79 for this scenario; 79 is reserved for unrelated procedures performed during the postoperative period.

05Does the 90-day global period cover all post-op visits?

It covers all routine post-op visits, wound checks, and dressing changes through day 90. If a visit addresses a problem unrelated to the THA, bill it with modifier 24. If a new surgical decision is made at a post-op visit, modifier 57 goes on the new E/M, not on 27130.

06When is modifier 22 appropriate for 27130?

Modifier 22 applies when the procedure is substantially more work than typical — for example, severe deformity, prior hardware complicating exposure, or extreme obesity adding significant operative time and complexity. Attach a cover letter quantifying additional time and complexity; payers require supporting documentation to pay the upcharge.

07Which ICD-10 codes are most commonly linked to 27130?

Primary osteoarthritis of the hip (M16.11 right, M16.12 left, M16.0 bilateral) drives the majority of 27130 claims. Post-traumatic arthritis, avascular necrosis (M87 series), and rheumatoid arthritis of the hip are also valid diagnoses — confirm the ICD-10 is supported by imaging and clinical notes.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures laterality, implant details (manufacturer, model, lot number), graft type if used, and the surgeon's explicit confirmation that this is a primary — not revision or conversion — arthroplasty. It also flags documentation of failed conservative treatment in the pre-op record. This prevents the most common denial triggers: wrong-code selection between 27130, 27132, and 27134–27138, missing laterality modifier, and insufficient medical necessity language.

See how Mira captures CPT 27130 documentation