Open surgical treatment of slipped capital femoral epiphysis (SCFE) using single or multiple pins, screws, or bone graft fixation to stabilize the displaced femoral head on the femoral neck.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,026.41
Total RVUs: 30.73
Global, days: 90
Region: Hip

Drawn from CMSAAPCFindacodeAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm open surgical exposure is documented — percutaneous approaches code differently (27175/27176)
Specify fixation method: single pin, multiple pins, cannulated screws, bone graft, or combination
Document graft harvest site and technique if autograft is used
Record the degree and direction of the slip (mild, moderate, severe) and whether it was stable or unstable
Include intraoperative fluoroscopy findings confirming guide wire and implant positioning
Document patient age and skeletal maturity status — this is a pediatric diagnosis tied to open physes

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 LT Left side RT Right side 24 Unrelated E/M during global 25 Significant separate E/M 57 Decision for surgery 58 Staged or related 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon 62 Co-surgeons

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27177 covers open treatment of slipped capital femoral epiphysis (SCFE), a pediatric hip condition in which the femoral head displaces posteriorly and inferiorly off the femoral neck through the growth plate (physis). Unlike the percutaneous approach reported with 27175 or 27176, code 27177 requires an open surgical exposure and uses pins, screws, or a bone graft — or a combination — to achieve fixation. The open approach is typically chosen when the slip is severe, unstable, or when anatomic reduction is required before fixation.

This code sits in the 27175–27181 SCFE family. The distinction between codes turns on approach (percutaneous vs. open) and technique (pin/screw vs. osteotomy with fixation). Billing the wrong code in this family — for example, reporting 27177 when only percutaneous fixation was performed — is a common audit trigger. Operative notes must unambiguously document the open exposure, the fixation method, and any graft harvest if applicable.

The 90-day global period applies. All routine post-op visits, wound checks, and hardware management are bundled through day 90. A separately documented and medically necessary service unrelated to the SCFE — such as treatment of a contralateral hip condition — requires modifier 79. If a complication drives an unplanned return to the OR for the same hip, use modifier 78.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	15.69
Practice expense RVU	11.7
Malpractice RVU	3.34
Total RVU	30.73
Medicare national rate	$1,026.41
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	$1,026.41
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 27177 get rejected.

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

Upcoding flag: percutaneous in-situ fixation documented but open code 27177 billed — auditors compare op note to code
Missing documentation of open exposure; note only describes guide wire and screw placement without describing the arthrotomy or incision
Global period conflict: separate E/M or follow-up visit billed within 90-day global without modifier 24
Bilateral procedure billed without LT/RT or 50 modifier when both hips are treated in the same session
Incorrect code selection within the SCFE family — 27177 vs. 27178 (with osteotomy) confusion leads to mismatched documentation

Frequently asked questions

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

01What distinguishes 27177 from 27175 and 27176?

27175 is closed treatment without manipulation; 27176 is percutaneous pin fixation. 27177 requires open surgical exposure. If you didn't open the hip, you're not in 27177 territory.

02When should 27178 be used instead of 27177?

27178 covers open treatment with osteotomy — meaning bone is cut to achieve reduction before fixation. If no osteotomy was performed, 27177 is correct.

03Can 27177 be billed bilaterally if both hips are treated in the same operative session?

Yes. Append modifier 50 for bilateral procedures on the same date, or use LT and RT on separate line items depending on payer preference. Document both hips separately in the operative note.

04Is prophylactic pinning of the contralateral hip reportable on the same date?

Prophylactic fixation of the unaffected hip is sometimes performed concurrently. Code the contralateral side with the appropriate percutaneous code (27175 or 27176) with the RT or LT modifier. Payer coverage for prophylactic pinning varies — verify before assuming reimbursement.

05What modifier applies if the patient returns to the OR within 90 days for hardware removal or a related complication?

Use modifier 78 for an unplanned return to the OR for a procedure related to the original SCFE surgery within the global period. Use modifier 79 for a distinct, unrelated procedure on a separate site.

06Does the 90-day global include post-op imaging to check hardware position?

Imaging ordered as part of routine post-op management is generally bundled. Diagnostic imaging for a new clinical concern — such as AVN evaluation — may be separately billable with supporting documentation, but payer policies vary.

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 open surgical approach, fixation construct (pin count, screw size, graft harvest site if applicable), intraoperative imaging confirmation, and slip severity from the surgeon's dictation. This prevents the most common denial for 27177: an operative note that reads like a percutaneous procedure but bills the open code — a mismatch auditors flag on pre-payment review.

See how Mira captures CPT 27177 documentation