Surgical · Hip

Bilateral pelvic osteotomy performed to correct congenital or developmental pelvic malalignment, typically in pediatric patients

Verified May 8, 2026 · 5 sources ↓

Medicare: $1,267.56
Total RVUs: 37.95
Global, days: 90
Region: Hip

Drawn from CMSAAPCNIH

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Named osteotomy technique used on each side (e.g., Dega, Salter) — not just 'pelvic osteotomy'
Confirmed bilateral execution with distinct operative description for each side
Diagnosis establishing congenital or developmental pelvic malalignment or hip dysplasia
Patient age and skeletal maturity status supporting pediatric indication
Intraoperative imaging use documented, including fluoroscopy if performed
Postoperative immobilization plan (e.g., spica cast application) if performed same session

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 51 Multiple procedures 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 XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 27158 covers bilateral pelvic osteotomy — a procedure that cuts and repositions pelvic bone on both sides to correct structural malalignment, most commonly in children with congenital hip dysplasia or developmental deformity. Techniques include Dega, Salter, and similar named osteotomies. The goal is to redirect the acetabulum to improve femoral head coverage, restore hip stability, and normalize joint mechanics before skeletal maturity.

This is a high-complexity pediatric procedure carrying a 90-day global period. All routine postoperative management through day 90 — including cast checks, wound care, and standard follow-up — is included in the surgical payment. Separate billing within the global window requires modifier 24 (unrelated E/M) or modifier 79 (unrelated procedure). Because this is inherently bilateral, no modifier 50 is appended — the bilateral nature is built into the code descriptor.

Documentation must clearly establish the diagnosis driving the osteotomy, the specific technique used on each side, intraoperative imaging use, and the pediatric patient's developmental or congenital indication. Vague operative notes citing only 'pelvic osteotomy' without naming the technique and confirming bilateral execution are a consistent audit target.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	20.51
Practice expense RVU	13.08
Malpractice RVU	4.36
Total RVU	37.95
Medicare national rate	$1,267.56
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	$1,267.56
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 27158 get rejected.

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

Operative note lacks named technique — generic 'pelvic osteotomy' language triggers medical necessity review
Bilateral nature not explicitly documented, causing payer to process as unilateral or query for modifier 50
Missing congenital or developmental diagnosis code tying clinical indication to procedure
Same-day ancillary procedures billed without modifier 59 or XS where NCCI edits apply
Global period violations — routine follow-up billed within 90 days without modifier 24

Frequently asked questions

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

01Does CPT 27158 require modifier 50 because it's bilateral?

No. The bilateral nature is built into the code descriptor. Appending modifier 50 would incorrectly signal two separate unilateral procedures and will likely trigger a denial or payment reduction.

02What diagnoses support medical necessity for 27158?

Congenital hip dysplasia (Q65.xx), developmental dysplasia of the hip, and similar congenital pelvic malalignment diagnoses are the primary ICD-10 drivers. The diagnosis must be documented in both the clinical record and the operative note to survive payer scrutiny.

03Can 27158 be billed same-day with femoral osteotomy codes?

Potentially yes, but check current NCCI PTP edits before billing them together. If performed as distinct procedures addressing separate anatomic problems, modifier 59 or XS may apply — but clinical circumstances must support the unbundling, not just the modifier.

04What is the global period for 27158 and what does it include?

27158 carries a 90-day global period. That covers the day-before visit, the surgery, and all routine postoperative care through day 90. Bill modifier 24 for unrelated E/M visits and modifier 79 for unrelated procedures performed within that window.

05Is 27158 performed in adults?

Rarely. The procedure is almost exclusively pediatric — pelvic osteotomy for congenital malalignment is most effective before skeletal maturity. Adult pelvic reconstruction typically uses different codes. Billing 27158 for an adult patient will invite medical necessity scrutiny and likely a documentation request.

06How does site of service affect payment for 27158?

HOPD and ASC payments differ significantly — see the Site of Service comparison on this page. Given the procedure's complexity and typical need for general anesthesia and intraoperative imaging, most cases are performed in a hospital setting rather than an ASC.

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 named osteotomy technique (Dega, Salter, etc.), confirms bilateral execution with side-specific operative detail, records the congenital or developmental diagnosis driving the procedure, and flags intraoperative fluoroscopy use. This prevents downcoding audits triggered by operative notes that omit technique names or fail to confirm that both sides were independently addressed.

See how Mira captures CPT 27158 documentation