Revision of total hip arthroplasty involving removal and replacement of the femoral component only, with or without bone graft.

Verified May 8, 2026 · 5 sources ↓

Medicare: $1,367.10
Total RVUs: 40.93
Global, days: 90
Region: Hip

Drawn from AAPCAAHKSCMS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Operative note must explicitly identify the femoral component as the component removed and replaced — generic language like 'hip revision performed' is insufficient.
Document whether bone graft was used and specify autograft, allograft, or none.
Record the condition of the acetabular component and the rationale for retaining it, confirming why a full revision (27134) was not indicated.
If modifier 52 is appended (e.g., isolated femoral head only), document that the femoral stem was retained and in acceptable condition.
For modifier 22 claims, include operative time, estimated blood loss, degree of femoral bone loss (Paprosky classification or equivalent), and specific technical obstacles encountered.
Medical necessity documentation must support the indication: component loosening, periprosthetic fracture, implant failure, infection with staged exchange, or other specific failure mechanism.

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 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 27138 covers surgical revision of a previously implanted total hip arthroplasty where only the femoral component is addressed. The surgeon removes the existing femoral stem, head, or both, and implants a new femoral prosthesis. Bone graft — autograft or allograft — may or may not be used depending on bone loss encountered. The code applies to full femoral component revision; if only a modular femoral head is exchanged without revising the stem, append modifier 52 to indicate reduced scope.

Component selection drives code selection for the entire hip revision family. If both acetabular cup and femoral stem are revised, use 27134. Isolated acetabular component revision goes to 27137. Use 27138 when the femoral side alone is revised. A common error is defaulting to 27134 for all hip revisions — the operative note must explicitly state which components were removed and replaced. Intra-articular drug-delivery devices removed incidentally during the revision are bundled and not separately reportable. Antibiotic-eluting beads prepared at the time of surgery and placed into the joint prior to closure may be separately reported with 20704.

The 90-day global period covers all routine post-op care through day 90. Unplanned returns to the OR for a related complication — such as dislocation or wound dehiscence — require modifier 78. A separate unrelated procedure in the global window needs modifier 79. Staged procedures planned before or at the time of surgery use modifier 58. Modifier 22 is appropriate when operative complexity significantly exceeds the typical revision — document operative time, blood loss, degree of bone loss, and specific technical challenges in the operative note to support it.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	23.11
Practice expense RVU	12.92
Malpractice RVU	4.9
Total RVU	40.93
Medicare national rate	$1,367.10
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	$1,367.10
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$9,113.60

Common denial reasons

The recurring reasons claims for CPT 27138 get rejected.

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

Wrong revision code selected — 27134 billed when only the femoral component was revised, or 27138 billed when both components were addressed.
Operative note lacks component-level specificity, leaving the payer unable to confirm femoral-only scope.
Modifier 52 missing when only a modular femoral head (not the stem) was exchanged, triggering a medical necessity mismatch.
Modifier 22 denied due to absence of supporting documentation for increased complexity — time, blood loss, and bone loss must be quantified in the note.
Global period violations when post-op services are billed without modifier 24 (unrelated E/M) or modifier 78 (unplanned related OR return).

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What is the difference between 27134, 27137, and 27138?

Component revised determines the code. 27134 = both acetabular and femoral components revised. 27137 = acetabular component only. 27138 = femoral component only. Using 27134 for every hip revision regardless of scope is the most common coding error in this family.

02When should modifier 52 be added to 27138?

Append modifier 52 when only the modular femoral head is exchanged but the femoral stem is retained. The operative note must confirm the stem was assessed and left in place. This applies to isolated head swaps — not full femoral component revisions.

03Can 27138 be billed with 20704 for antibiotic beads?

Yes. If resorbable antibiotic-eluting beads are manually prepared at the time of surgery and inserted into the joint prior to closure, 20704 is separately reportable alongside 27138. Routine irrigation is not separately reportable.

04What modifier applies if the patient returns to the OR for a dislocation after 27138?

Modifier 78 — unplanned return to the OR for a related procedure during the global period. Do not use modifier 79 for a dislocation; 79 is for unrelated procedures. The global period for 27138 is 90 days.

05Is 27138 typically performed in an ASC or inpatient hospital?

Hip revision arthroplasty is most commonly performed in the inpatient setting (place of service 21). ASC billing is possible for select cases, and CMS publishes separate HOPD and ASC payment rates — see the Site of Service comparison table on this page.

06What ICD-10-CM codes support medical necessity for 27138?

Common diagnoses include aseptic loosening, periprosthetic fracture, implant failure, instability or dislocation, and infection with staged exchange. AAHKS publishes a cross-reference of ICD-10 codes mapped specifically to 27134, 27137, and 27138 — link in sources below.

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 femoral components revised (stem, head, or both), whether the acetabular component was inspected and retained or revised, graft type used, Paprosky bone loss grade, operative time, and estimated blood loss. This prevents the most common 27138 audit flag: an operative note that documents a hip revision without confirming which components were removed — leaving coders unable to defend femoral-only code selection against a 27134 downcode or denial.

See how Mira captures CPT 27138 documentation