Surgical · Hip

Femoral neck osteotomy in which a wedge of bone is resected from the femoral neck to correct alignment between the femoral head and shaft.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,115.59
Total RVUs: 33.4
Global, days: 90
Region: Hip

Drawn from CMSFastrvuAAOSAoassn

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Preoperative diagnosis specifying the femoral neck deformity or angular abnormality being corrected
Operative note naming the surgical approach (e.g., anterior, anterolateral, posterior) — not 'standard approach'
Description of osteotomy type (wedge, closing, opening) and correction angle achieved
Fixation construct used (blade plate, dynamic hip screw, locking plate) with hardware specifics
Inpatient admission order and supporting medical necessity documentation, required for CMS reimbursement
Imaging (AP pelvis, lateral hip x-rays) confirming deformity measurement used to plan the correction

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 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 7 cited references ↓

CPT 27161 covers an open osteotomy of the femoral neck — surgically cutting and reshaping bone at the junction between the femoral head and shaft to correct angular deformity or malalignment. The procedure is distinct from intertrochanteric or subtrochanteric osteotomies and targets the neck segment specifically. Indications include coxa vara, sequelae of prior hip pathology, or deformity correction in younger patients where joint preservation is the goal.

This is an inpatient-only procedure under CMS. Status indicator 'C' means Medicare will not reimburse it in an HOPD or ASC setting — the claim must reflect an inpatient hospital admission. Any facility billing outside that setting will face automatic denial. The 90-day global period applies, so all routine postoperative care through day 90 is bundled into the surgical payment.

Documentation must clearly establish the deformity being corrected, the surgical approach, the type and angle of the osteotomy performed, and the fixation method used. Operative notes that omit the specific cut geometry or describe the approach as 'standard' create audit exposure and complicate appeals if bundling disputes arise.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	17.44
Practice expense RVU	12.25
Malpractice RVU	3.71
Total RVU	33.4
Medicare national rate	$1,115.59
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	$1,115.59
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 27161 get rejected.

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

Billed in outpatient or ASC setting — 27161 is CMS inpatient-only (status indicator C); facility claims outside inpatient will deny automatically
Diagnosis code mismatch — ICD-10 must reflect a femoral neck deformity or condition justifying osteotomy, not just 'hip pain'
Operative note lacks osteotomy geometry or correction angle, triggering medical necessity denial on audit
Unbundling of incidental services (e.g., fluoroscopy guidance) without documented separate indication, per NCCI bundling principles
Global period conflict — postoperative services billed without modifier 24 or 25 when an unrelated E/M is performed during the 90-day window

Frequently asked questions

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

01Can CPT 27161 be performed and billed in an ASC?

No. CMS assigns 27161 status indicator 'C' — inpatient-only. Medicare will not pay this code in an ASC or hospital outpatient setting. The patient must be admitted as an inpatient for the claim to process.

02What modifier applies if a complication requires unplanned return to the OR during the 90-day global?

Use modifier 78 for an unplanned return to the OR for a complication related to 27161. Modifier 79 applies only if the return procedure is entirely unrelated to the original femoral neck osteotomy. Do not invert these.

03How does the 90-day global period affect postoperative E/M billing?

Routine post-op visits through day 90 are bundled and not separately billable. If you see the patient for an unrelated problem during that window, append modifier 24 to the E/M code and document the unrelated nature clearly in the note.

04When is modifier 22 appropriate for 27161?

Modifier 22 applies when the procedure is substantially more complex than typical — for example, severe deformity, prior hardware removal required, or significantly increased operative time. Document the additional work explicitly in the operative note; payers require that to support the upward payment adjustment.

05What ICD-10 diagnoses most commonly support medical necessity for 27161?

Coxa vara (M16.x series), femoral neck deformity as a sequela of prior fracture or Legg-Calvé-Perthes disease, and congenital or acquired angular deformity of the proximal femur are the typical supporting diagnoses. Hip pain alone will not carry a claim for an osteotomy.

06Can modifier 62 be used if two surgeons perform the osteotomy together?

Yes. If the complexity legitimately requires two surgeons operating simultaneously, both bill 27161 with modifier 62. Each operative note must document the distinct role each surgeon performed; identical notes are an audit red flag.

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 femoral neck osteotomy approach, correction angle and osteotomy geometry, fixation construct, and intraoperative fluoroscopy use directly from dictation. This prevents the most common audit flag for 27161 — operative notes that document the hip was 'cut and plated' without specifying the wedge type or degrees of correction achieved, which undermines medical necessity on review.

See how Mira captures CPT 27161 documentation