Open treatment of slipped femoral capital epiphysis with osteotomy and internal fixation
Verified May 8, 2026 · 4 sources ↓
- Medicare
- $1,032.42
- Total RVUs
- 30.91
- 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 4 cited references ↓
- Operative note must name the specific osteotomy type (e.g., base-of-neck, intertrochanteric, subtrochanteric Southwick) — 'osteotomy performed' alone is insufficient for audit.
- Pre-op imaging (AP and frog-leg lateral pelvis radiographs) confirming SCFE diagnosis, slip grade, and affected side(s).
- Documentation of internal fixation method, hardware type, and number of fixation devices placed.
- Confirmation of open approach — distinguish from closed manipulation with pinning (27178), which does not involve osteotomy.
- Patient age and growth plate status documented, as SCFE is a pediatric/adolescent diagnosis and age-incongruent billing draws scrutiny.
- If bilateral procedure: separate documentation of findings and fixation for each hip, supporting modifier 50 use.
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 4 cited references ↓
CPT 27181 describes open surgical correction of a slipped femoral capital epiphysis (SCFE) performed via osteotomy with internal fixation. This is the highest-complexity SCFE procedure code in the 27175–27181 family. Unlike in-situ pinning (27176) or open pinning with bone graft (27177), 27181 involves cutting and repositioning the proximal femur — typically a base-of-neck or intertrochanteric osteotomy — then securing the corrected alignment with internal hardware.
The 90-day global period covers the operative day, the day-before visit, and all routine post-op management through day 90. Separate E/M visits during the global window require modifier 24 (unrelated) or 25 (same-day, significant and separately identifiable). A return to the OR for a related complication — hardware failure, wound irrigation, reduction loss — bills with modifier 78. An unrelated procedure during the global uses modifier 79.
Because SCFE primarily affects adolescents, payer mix often skews toward commercial insurers and Medicaid rather than Medicare. Medicaid policies on SCFE procedures vary by state; verify prior authorization requirements and any state-specific coverage criteria before scheduling. Bilateral SCFE correction at the same operative session — uncommon but documented — bills with modifier 50.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 15.78 |
| Practice expense RVU | 11.78 |
| Malpractice RVU | 3.35 |
| Total RVU | 30.91 |
| Medicare national rate | $1,032.42 |
| 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 | $1,032.42 |
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 27181 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Upcoding flag: payer downcodes to 27176 (in-situ pinning) when operative note does not explicitly describe osteotomy with bone repositioning.
- Missing prior authorization — many commercial and Medicaid plans require it for major open hip procedures on pediatric patients.
- Incorrect modifier on same-day E/M: billing a separate office visit the day of surgery without modifier 25, causing the E/M to bundle into the surgical package.
- Bilateral billing error: reporting two separate line items for bilateral SCFE instead of a single line with modifier 50, triggering duplicate-procedure denial.
- ICD-10 mismatch: using an adult femoral fracture code instead of the correct SCFE-specific code (M93.0x series), prompting medical necessity denial.
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 4 cited references ↓
01What separates 27181 from 27177 and 27178?
02Can 27181 and 27176 be billed together for bilateral SCFE treated differently on each side?
03What ICD-10 codes are used with 27181?
04Does the 90-day global affect management of hardware complications?
05Is 27181 performed in an ASC or HOPD setting, and does it matter for reimbursement?
06When does modifier 22 apply to 27181?
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 osteotomy type by name, the internal fixation construct, and the operative side directly from surgeon dictation. That detail prevents downcoding to a lower-complexity SCFE code and gives audit reviewers the specificity they need without a post-op addendum.
See how Mira captures CPT 27181 documentation