Surgical · Hip

Osteotomy of the iliac, acetabular, or innominate bone performed with open reduction of the hip joint to correct dislocation and restore normal alignment.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,326.02
Total RVUs: 39.7
Global, days: 90
Region: Hip

Drawn from AAPCJposnaCMSFindacode

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify which bone was cut — iliac, acetabular, or innominate — by name in the operative note
Confirm open reduction of the hip was performed and document the reduction technique and intraoperative hip stability assessment
Document preoperative imaging (X-ray, MRI, or CT) demonstrating dislocation or dysplasia requiring surgical correction
Include the approach by name (e.g., Smith-Petersen, anterior, anterolateral) — operative notes that reference only 'standard approach' are audit flags
Record the patient's age, diagnosis (e.g., DDH, residual acetabular dysplasia), and any prior hip procedures, including prior closed reductions or casting
Document medical necessity: failed conservative management, functional limitations, or radiographic evidence of progressive deformity

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 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 27147 covers an iliac, acetabular, or innominate osteotomy combined with open reduction of the dislocated hip — both elements must be performed for this code to apply. The surgeon cuts through one of the pelvic bones (ilium, acetabulum, or innominate) and simultaneously reduces the hip joint through an open approach. This is the key distinction from 27146, which covers the osteotomy alone without open reduction. If only the osteotomy is performed — no open reduction — bill 27146, not 27147.

This code appears most frequently in pediatric hip preservation contexts: residual developmental dysplasia of the hip (DDH), failed closed reduction, and acetabular dysplasia requiring structural correction. Adult applications exist but are less common. Do not confuse 27147 with revision arthroplasty codes (27134, 27137, 27138) — those involve removal and replacement of prosthetic components, a categorically different procedure.

The 90-day global period applies. All routine post-op care through day 90 is bundled. Unrelated E/M services during that window require modifier 24; unrelated procedures require modifier 79. If a complication requires a return to the OR for a related procedure, use modifier 78.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	21.52
Practice expense RVU	13.6
Malpractice RVU	4.58
Total RVU	39.7
Medicare national rate	$1,326.02
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	$1,326.02
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,682.29

Common denial reasons

The recurring reasons claims for CPT 27147 get rejected.

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

Billed as 27147 when open reduction was not performed — payers will downcode to 27146 if the operative note describes osteotomy only
Diagnosis code mismatch — submitting with a DX that does not support dislocation or structural dysplasia requiring open correction
Unbundling: separately billing the osteotomy (27146) and open reduction when 27147 is the correct single code for the combined procedure
Missing or vague operative documentation — notes that do not explicitly describe the open reduction step trigger medical necessity reviews
Incorrect use for prosthetic revision — 27147 is not a revision arthroplasty code; payers may deny if the patient history shows prior THA implants without clarifying documentation

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What is the difference between CPT 27146 and CPT 27147?

27146 is the osteotomy alone — iliac, acetabular, or innominate — without open reduction. 27147 adds the open reduction of the hip. If both are performed in the same session, bill 27147. Billing 27146 when an open reduction was also done undercodes the work.

02Can 27147 be billed for a revision of a hip prosthesis?

No. Prosthetic component revision is covered under 27134 (both components), 27137 (acetabular only), or 27138 (femoral only). CPT 27147 is a pelvic osteotomy with open reduction — not a prosthetic revision procedure. Using 27147 for an implant revision will not pass payer scrutiny.

03What global period applies to 27147?

90-day global. The day-before visit, the surgery, and all routine post-op care through day 90 are bundled. Bill unrelated E/M services during that period with modifier 24, and unrelated same-period procedures with modifier 79.

04Is CPT 27147 appropriate for a Pemberton or Dega osteotomy with open reduction?

Yes. A single-cut iliac osteotomy (Pemberton, Dega) performed with open reduction of the hip maps to 27147. If the open reduction is not performed in the same session, use 27146 instead. A triple innominate osteotomy codes differently — check payer guidance and consider unlisted codes when no existing CPT accurately reflects the work.

05When is modifier 22 appropriate for 27147?

Modifier 22 applies when the procedure is substantially more complex than typical — for example, a patient with prior failed reduction attempts, significant scarring, or complex anatomy that materially increases operative time and effort. Document the specific factors in the operative note and attach a cover letter. Payers audit modifier 22 claims routinely.

06Can 27147 be billed bilaterally?

Bilateral pelvic osteotomy with open reduction in a single session would require modifier 50 (or LT/RT per payer preference). Bilateral hip dysplasia correction is uncommon but not impossible — the medical record must clearly support necessity for both sides, and some payers require prior authorization for bilateral hip procedures.

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 bone osteotomized (iliac, acetabular, or innominate), the open reduction technique, intraoperative hip stability findings, the surgical approach by name, and the underlying diagnosis driving the procedure. This prevents the most common 27147 denial: an operative note that documents the osteotomy but fails to explicitly confirm open reduction was performed — causing payers to downcode to 27146.

See how Mira captures CPT 27147 documentation