Surgical · Hip

Iliac, acetabular, or innominate bone osteotomy performed in conjunction with a femoral osteotomy to correct hip joint alignment.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,428.56
Total RVUs: 42.77
Global, days: 90
Region: Hip

Drawn from CMSAAPCFastrvuEmednyAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify the specific bones cut: iliac, acetabular, or innominate — and confirm femoral osteotomy was performed in the same session
Document the indication driving both osteotomies (e.g., acetabular dysplasia, residual deformity, insufficient femoral head coverage)
Specify fixation method used for each osteotomy site (plates, screws, pins, external fixator) — bundled but must be in the operative note
Record pre- and post-correction alignment or coverage angles (e.g., center-edge angle, acetabular index) when available from imaging
Note the patient's age and skeletal maturity, which affect medical necessity review for pelvic osteotomy procedures
Confirm laterality (left, right, or bilateral) explicitly in the operative report header and body

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

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27151 covers a combined pelvic and femoral osteotomy: the surgeon cuts and repositions the iliac, acetabular, or innominate bone to reorient the hip socket, and simultaneously performs a femoral osteotomy to correct the proximal femur alignment. Both cuts are addressed in a single operative session. This is the step up from 27146 (iliac osteotomy alone) — if you're doing the pelvic osteotomy without the femoral component, 27146 is the right code. Add the open reduction of the hip and you're at 27156.

This procedure is most commonly used for developmental dysplasia of the hip, residual deformity from pediatric hip conditions, or acquired acetabular insufficiency where a single-bone correction won't achieve adequate joint coverage. The 90-day global period covers all routine post-op management through day 90. Internal or external fixation placed at the time of the osteotomy is bundled — don't bill it separately. Hardware removal after the global period, if required, is separately reportable.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	23.52
Practice expense RVU	14.24
Malpractice RVU	5.01
Total RVU	42.77
Medicare national rate	$1,428.56
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	$1,428.56
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 27151 get rejected.

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

Billing 27151 when only the pelvic osteotomy was performed — use 27146 if no femoral osteotomy was done
Separately billing internal fixation placed during the osteotomy — it is bundled into 27151
Missing or vague medical necessity documentation; payers require imaging-supported diagnosis codes (e.g., hip dysplasia, malformation) tied to the claim
Laterality not specified when modifier LT or RT is required by the payer, triggering edit or rejection
Upcoding to 27156 when open reduction of the hip was not performed — 27156 requires documented open reduction in addition to both osteotomies

Frequently asked questions

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

01What is the difference between 27146, 27147, 27151, and 27156?

27146 is the iliac/acetabular/innominate osteotomy alone. 27147 adds open reduction of the hip. 27151 adds a femoral osteotomy to the pelvic cut. 27156 includes both the femoral osteotomy and open reduction of the hip. Pick the code that matches exactly what was done — each is a distinct procedure, not an add-on.

02Is internal fixation separately billable with 27151?

No. Fixation placed at the time of the osteotomy — plates, screws, pins, or external fixator — is bundled into 27151. Bill it separately only if it is applied in a subsequent, separate operative session.

03Can 27151 be billed bilaterally?

Yes, if bilateral pelvic and femoral osteotomies are performed. Append modifier 50 for a bilateral procedure billed on one line, or use LT and RT on separate lines per payer preference. Medicare typically accepts modifier 50 on a single line.

04What modifier applies if the surgeon performs an unrelated procedure during the 90-day global period?

Use modifier 79 for an unrelated procedure performed by the same surgeon during the global period. Modifier 78 is for an unplanned return to the OR for a related complication — do not mix them up; inverting these is an audit flag.

05Which diagnosis codes typically support medical necessity for 27151?

Hip dysplasia (Q65-series), acquired deformity of the hip (M21-series), and sequelae of pediatric hip conditions such as Legg-Calvé-Perthes disease (M91-series) are the most commonly accepted. Payers want imaging-supported documentation — include CE angle or acetabular index values in the record.

06If the surgeon only intended to do a pelvic osteotomy but added a femoral osteotomy intraoperatively, can modifier 22 be used?

Not in place of accurate code selection — 27151 already captures both osteotomies. Use modifier 22 only if the combined procedure was substantially more work than typical for 27151, with documentation explaining the unusual complexity.

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 bones osteotomized (iliac, acetabular, or innominate), confirms the femoral osteotomy was performed in the same session, records fixation method and laterality, and pulls the pre-operative diagnosis including imaging measurements. This prevents the most common downcode to 27146 — which happens when the operative note describes the pelvic cut but buries or omits the femoral component.

See how Mira captures CPT 27151 documentation