Osteotomy of the iliac, acetabular, or innominate bone with concurrent femoral osteotomy and reduction of hip dislocation
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $1,533.44
- Total RVUs
- 45.91
- Global, days
- 90
- Region
- Hip
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 6 cited references ↓
- Specify each osteotomy performed by name — iliac, acetabular, innominate, and/or femoral — and document that all components were completed
- Operative note must describe the degree of correction achieved and confirm hip reduction was performed
- Preoperative imaging (AP pelvis, frog-leg lateral) documenting structural hip dysplasia or dislocation requiring surgical correction
- Failed or inadequate conservative treatment history establishing medical necessity for bilateral or unilateral surgical intervention
- Document the surgical approach by name (e.g., Smith-Petersen, Watson-Jones) — notes that reference only 'standard approach' flag in audit
- If modifier 22 is appended, the operative note must quantify the additional work and explain why complexity exceeded typical — surgeon attestation alone is insufficient
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 6 cited references ↓
CPT 27156 describes a combined pelvic and femoral osteotomy procedure performed to correct hip dysplasia or structural malalignment. The surgeon cuts the iliac, acetabular, or innominate bone to reorient the acetabular socket, then performs a separate femoral osteotomy to correct the proximal femur alignment, and reduces the dislocated hip. This is a high-complexity reconstructive procedure, not a simple revision — the dual osteotomy component drives its substantial RVU weight.
The 90-day global period covers the surgery date, the day-before decision visit (modifier 57 required on the E/M), and all routine postoperative care through day 90. Separate billing for cast changes, dressing care, or routine follow-up visits during the global window will deny without modifiers 24 or 79 paired with a distinct, unrelated diagnosis.
Site of service matters significantly for this code. HOPD and ASC facility payments differ — see the site-of-service comparison table on this page. Most payers, including Medicare, require prior authorization for elective hip reconstructive procedures of this magnitude. Confirm coverage criteria and document medical necessity with imaging, failed conservative treatment history, and functional status before scheduling.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 25.57 |
| Practice expense RVU | 14.89 |
| Malpractice RVU | 5.45 |
| Total RVU | 45.91 |
| Medicare national rate | $1,533.44 |
| 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 | $1,533.44 |
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 27156 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing prior authorization — most commercial payers and Medicare Advantage plans require it for elective pelvic/femoral reconstructive procedures
- Operative note documents only one osteotomy (pelvic or femoral) rather than the combined procedure required for 27156
- Medical necessity not established — absence of imaging or documented failed conservative management in the record
- Bundling conflict when additional musculoskeletal codes are billed same-day without a modifier establishing distinct procedural independence
- Global period violation — routine post-op visits billed without modifier 24 or 79 during the 90-day window
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What distinguishes 27156 from other hip osteotomy codes like 27146 or 27151?
02Can 27156 be billed bilaterally in the same session?
03Does modifier 57 apply to the decision visit for 27156?
04What ICD-10 diagnoses support medical necessity for 27156?
05If a complication requires return to the OR within the 90-day global, what modifier applies?
06Is 27156 performed in an ASC setting, or does it require inpatient?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57683
- 03cms.govhttps://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-policy-manual
- 04cms.govhttps://www.cms.gov/files/document/2025nccimedicarepolicymanualcompletepdf.pdf
- 05cms.govhttps://www.cms.gov/files/document/04-chapter4-ncci-medicare-policy-manual-2025finalcleanpdf.pdf
- 06aaos.orghttps://www.aaos.org/globalassets/quality-and-practice-resources/coding-and-reimbursement/resident-guide/resident-guide_modifiers.pdf
Mira AI Scribe
Mira's AI scribe captures the specific bones osteotomized (iliac, acetabular, innominate, femoral), the degree of correction, confirmation of hip reduction, surgical approach by name, and intraoperative findings from dictation. That structured capture prevents the most common audit flag for 27156 — operative notes that describe only one osteotomy component, which misrepresents the procedure and triggers downcoding or denial.
See how Mira captures CPT 27156 documentation