Surgical stabilization of a slipped capital femoral epiphysis (SCFE) using single or multiple pins inserted in situ through percutaneous stab incisions.

Verified May 8, 2026 · 6 sources ↓

Medicare: $856.73
Total RVUs: 25.65
Global, days: 90
Region: Hip

Drawn from CMSNIHFindacodeAAPC

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Explicit laterality (left, right, or bilateral) stated in the operative note and on the claim
Imaging confirmation of SCFE grade/classification (mild, moderate, severe) documented pre-operatively
Number of pins or screws placed and their positioning relative to the physis
Fluoroscopic confirmation of hardware position noted in the operative report — even though fluoroscopy is not separately billable
Stability classification of the slip (stable vs. unstable per Loder criteria) to support medical necessity
Patient age and skeletal maturity documented, as this code is specific to open physeal patients
Any intraoperative complications or deviation from standard technique that would support modifier 22

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 76 Repeat, same physician 77 Repeat, another physician 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 6 cited references ↓

CPT 27176 describes in situ pinning of a slipped capital femoral epiphysis — the condition in which the femoral head displaces posteriorly and inferiorly off the femoral neck at the physis. The surgeon places one or more cannulated screws or pins through small stab incisions under fluoroscopic guidance, crossing the physis to halt further slip progression without attempting to reduce the deformity. No open arthrotomy is required. This is the most common surgical approach for stable SCFE and is distinct from 27175 (open bone graft epiphysiodesis) and 27177 (open reduction with internal fixation).

The 90-day global period covers the surgery, the pre-operative day-before visit, and all routine postoperative management through day 90. Any unrelated procedure performed by the same surgeon during that window requires modifier 79. An unplanned return to the OR for a related complication — such as hardware revision for cutout — uses modifier 78. Fluoroscopy used intraoperatively is integral to the pinning and cannot be billed separately under NCCI policy.

Because SCFE is predominantly a pediatric condition, the treating provider is most often a pediatric orthopedic surgeon. Bilateral simultaneous SCFE pinning is reported with modifier 50. Document laterality explicitly; payers routinely deny claims where the operative note does not specify left or right hip.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	12.6
Practice expense RVU	10.37
Malpractice RVU	2.68
Total RVU	25.65
Medicare national rate	$856.73
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	$856.73
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI J8) Ambulatory surgical center (freestanding)	$2,084.06

Common denial reasons

The recurring reasons claims for CPT 27176 get rejected.

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

Missing or ambiguous laterality on claim — payers deny when LT/RT modifier is absent or conflicts with the operative note
Fluoroscopy billed separately (e.g., 77002) — bundled into 27176 under NCCI; no modifier bypasses this
Incorrect code selection — 27177 (open reduction) billed when the slip was treated in situ without reduction attempt
Medical necessity not established — absent pre-operative imaging report or clinical documentation of SCFE diagnosis
Global period overlap — post-op E&M visits billed without modifier 24 when unrelated, or without modifier 79 for unrelated procedures

Frequently asked questions

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

01What is the difference between CPT 27176 and 27175?

27175 is an open bone graft epiphysiodesis — a more involved procedure requiring arthrotomy and physeal grafting. 27176 is percutaneous in situ pinning without opening the joint. If you performed a true in situ pinning through stab incisions only, 27176 is correct.

02Can fluoroscopy be billed separately with 27176?

No. Intraoperative fluoroscopy is integral to percutaneous pin placement under NCCI policy. Billing a separate fluoroscopy code (e.g., 77002) alongside 27176 will be denied, and no modifier bypasses this edit.

03How do you bill bilateral SCFE pinning done in the same operative session?

Report 27176 once with modifier 50 for bilateral procedures. Alternatively, some payers accept 27176-LT and 27176-RT on separate lines with modifier 51 on the second. Confirm your payer's preference before submitting.

04Which modifier applies if the patient returns to the OR during the global period for a broken screw?

Use modifier 78 — unplanned return to the operating room for a related procedure within the global period. Hardware failure following SCFE pinning is directly related to the index procedure.

05Does routine screw removal after physeal closure bill separately from 27176?

If removal occurs within the 90-day global, it is included and cannot be billed separately. After the global closes, screw removal is reportable under 20680 (removal of deep implant). Document that the physes have closed and the global period has expired.

06When is modifier 22 justified for 27176?

Modifier 22 requires documentation of substantially increased intraoperative work — for example, severe slip requiring complex pin trajectory planning, significant obesity complicating access, or an unstable slip with AVN risk requiring extended OR time. The operative note must quantify the additional time and describe the specific difficulty. A brief mention of 'difficult anatomy' alone won't support it.

07What ICD-10 codes pair with 27176?

The primary diagnosis is typically M93.00–M93.03 (slipped upper femoral epiphysis, unspecified/acute/chronic/acute-on-chronic, with laterality subcode). Confirm the slip type and laterality match between the ICD-10 code and LT/RT modifier on the claim — mismatches are a leading denial trigger.

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 slip stability classification, number and type of fixation devices placed, fluoroscopic confirmation language, and explicit laterality directly from the surgeon's dictation. This prevents the two most common 27176 denials: missing laterality modifiers and unsupported modifier 22 claims where increased complexity wasn't documented at the time of service.

See how Mira captures CPT 27176 documentation