Revision of total hip arthroplasty involving replacement of both the femoral and acetabular components in a single operative session.

Verified May 8, 2026 · 8 sources ↓

Medicare: $1,695.43
Total RVUs: 50.76
Global, days: 90
Region: Hip

Drawn from CMSAAPCKzanowAthelasCPT

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Operative note must explicitly identify both femoral and acetabular components as removed and replaced; notes stating only 'revision performed' are insufficient for audit.
Indication for revision documented with specificity — aseptic loosening, periprosthtic infection, instability, wear, or periprosthetic fracture — matched to a covered ICD-10 code per the applicable MAC LCD.
For modifier 22: quantify increased complexity in the operative note — e.g., extensive bone loss, hardware removal difficulty, use of augments or structural graft, prolonged OR time — prior authorization or appeal letters should echo this language.
For staged infection protocols: document spacer placement at stage one and spacer removal with definitive implantation at stage two; CPT Assistant (September 2021) confirms spacer removal is inherent to 27134 at the second stage and should not be coded separately.
Imaging (X-ray or CT) in the pre-op record confirming component failure, loosening, or other indication supporting necessity.
Implant log or materials documentation confirming both new femoral and acetabular components were implanted, including graft use if applicable.

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 52 Reduced services 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

CPT 27134 covers a full revision hip arthroplasty where both the femoral component (head and stem) and the acetabular component are removed and replaced. Use this code when the operative report documents work on both sides of the prosthetic construct. If only the acetabular component is revised, bill 27137. If only the femoral head or acetabular liner is exchanged but the stem and cup remain, 27134-52 is the correct approach — modifier 52 signals reduced scope, not a different code.

The 90-day global period means all routine post-op hip care from the day of surgery through day 90 is bundled. E/M visits unrelated to the revision during that window require modifier 24. An unplanned return to the OR for a complication related to the revision takes modifier 78. A planned staged procedure — common in two-stage infection protocols where a spacer is placed first, then a definitive revision — requires modifier 58 on the second surgery. When the second stage falls within the global of the first, 27134-58 is mandatory or the claim will be denied as a global-period duplicate.

Medical necessity documentation must satisfy CMS LCD L34163 and Local Coverage Article A56796 (Novitas) or the equivalent MAC-specific article. ICD-10 codes must map precisely to a covered indication — aseptic loosening, periprosthetic fracture, instability, infection, wear — and the operative note must corroborate whichever diagnosis drives the claim. Vague language such as 'failed THA' without specificity invites medical necessity denials.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	29.52
Practice expense RVU	14.96
Malpractice RVU	6.28
Total RVU	50.76
Medicare national rate	$1,695.43
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	$1,695.43
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$9,325.76

Common denial reasons

The recurring reasons claims for CPT 27134 get rejected.

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

Global-period conflict: claim submitted without modifier 78 or 58 when the revision falls within the 90-day global of a prior hip procedure — payer bundles it as included post-op care.
Medical necessity: ICD-10 code does not appear on the MAC's covered-diagnosis list for 27134, or operative documentation does not support the diagnosis billed.
Modifier 22 denial: operative note lacks specific complexity language — time alone is not sufficient; bone loss grade, graft use, or hardware complexity must be documented.
Component specificity mismatch: 27134 billed when only one component was fully revised; payer downcodes to 27137 or 27138, or denies outright for inconsistency between claim and operative note.
Unbundling of spacer removal at second-stage infection revision: reporting spacer removal separately from 27134 at the second stage triggers an NCCI or payer edit; spacer removal is inherent per CPT Assistant September 2021.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01When does 27134 need modifier 52?

Append modifier 52 when only the femoral head and acetabular liner are exchanged but the femoral stem and acetabular cup remain. You're revising parts of both components, not the full construct — so 27134-52 signals reduced scope. If only one full component side is revised, use 27137 (acetabular only) or 27138 (femoral head only), also with modifier 52 if further reduced.

02How do you bill the second stage of a two-stage infection revision?

Bill 27134 for the second stage when the definitive implants are placed. If it falls within the global period of the first-stage surgery, append modifier 58 — this is a planned staged procedure, not a complication-driven return. Do not report spacer removal separately; per CPT Assistant September 2021, it is inherent to the revision code.

03What modifier applies if the patient returns to the OR unexpectedly due to dislocation or hematoma after the revision?

Use modifier 78. That signals an unplanned return to the OR for a procedure related to the original revision during the global period. Modifier 79 is for unrelated procedures in the global — do not confuse the two.

04Can 27134 be billed bilaterally?

Yes, if both hips are revised in the same session. Bill 27134-50 or use 27134-LT and 27134-RT on separate lines depending on payer preference. Bilateral simultaneous revision is uncommon; document the clinical rationale for same-session bilateral surgery.

05Which ICD-10 codes are commonly accepted for 27134 under Medicare?

Covered indications vary by MAC but typically include aseptic loosening (T84.030A–T84.039A), periprosthetic infection (T84.50XA–T84.59XA), instability, wear of prosthetic components, and periprosthetic fracture. Always verify against your specific MAC's LCD and Local Coverage Article — Novitas A56796 and First Coast A57765 are the primary references for their jurisdictions.

06What distinguishes 27134 from 27137 and 27138?

27134 = both femoral and acetabular components revised. 27137 = acetabular component only. 27138 = femoral component only (typically femoral head). If the full acetabular component and femoral head are revised but the stem is untouched, current CPT guidance directs 27134-52 rather than 27137, because both component sides were addressed even if not completely.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the specific components revised (femoral head, femoral stem, acetabular cup, liner), reason for revision (loosening, infection, instability, wear, fracture), bone graft use, and any complexity factors such as hardware removal difficulty or significant bone defect — all in the operative note at the time of dictation. That prevents the most common 27134 audit flag: an operative note that documents a revision without specifying both components or the clinical indication, which triggers medical necessity denials and modifier 22 rejections.

See how Mira captures CPT 27134 documentation