Prophylactic reinforcement of the femoral neck and proximal femur using internal fixation implants — nails, plates, or screws — with or without bone cement (methylmethacrylate), to prevent pathologic fracture.

Verified May 8, 2026 · 6 sources ↓

Medicare: $919.86
Total RVUs: 27.54
Global, days: 90
Region: Hip

Drawn from CMSAAPCAAHKS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Imaging (X-ray, CT, or MRI) confirming the lytic lesion or bone defect location and extent in the femoral neck or proximal femur
Explicit statement that the femur was NOT completely fractured at time of surgery — distinguishes 27187 from fracture treatment codes
Operative note naming the specific implants used (nail, plate, screw type and size) and whether methylmethacrylate was used
Laterality documented in both the H&P and operative note — left or right hip must be unambiguous
Indication for prophylactic fixation: pathologic diagnosis (e.g., metastatic carcinoma, myeloma), Mirel score or equivalent clinical risk assessment, or attending's clinical judgment with supporting imaging
Pre-operative conservative management or oncologic workup, or documented reason why prophylactic fixation was indicated without further delay

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 LT Left side RT Right side AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27187 describes surgical reinforcement of the femoral neck and proximal femur when bone integrity is compromised but fracture has not yet occurred. The surgeon places internal fixation devices — nails, plates, screws, or a combination — to stabilize the at-risk segment. Bone cement (methylmethacrylate) may be used as an adjunct to fill defects and augment fixation; its use does not change the code.

The procedure is most commonly indicated for impending pathologic fracture due to metastatic disease, myeloma, or other lytic lesions of the proximal femur. Distinguishing 27187 from fracture repair codes (e.g., 27236, 27244) requires clear documentation that the bone was intact — or at most incompletely fractured — at the time of intervention. If the femur is already fractured, a fracture treatment code applies instead.

This code carries a 90-day global period. All routine follow-up care, wound checks, and implant monitoring visits through day 90 are included. Billing a separate E/M in the global window requires modifier 24 (unrelated condition) or 58 (staged/related procedure in the postoperative period). Because the procedure is performed on a single extremity, LT or RT must be appended to identify laterality on every claim.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	13.87
Practice expense RVU	10.73
Malpractice RVU	2.94
Total RVU	27.54
Medicare national rate	$919.86
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	$919.86
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,343.09

Common denial reasons

The recurring reasons claims for CPT 27187 get rejected.

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

Missing laterality modifier (LT or RT) — claim will reject or pend at many MACs without it
Code billed when fracture was already complete at surgery — payer downcodes or denies in favor of a fracture treatment code such as 27244
Medical necessity not established: operative note lacks imaging evidence of impending fracture risk or oncologic diagnosis supporting prophylactic intent
Global period violation: routine post-op E/M billed without modifier 24 or 58 within the 90-day window
Unbundling of bone cement application — methylmethacrylate use is included in 27187 and cannot be separately reported

Frequently asked questions

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

01What is the difference between CPT 27187 and CPT 27244?

27187 is for prophylactic fixation of an intact or incompletely fractured femur at risk for pathologic fracture. 27244 is for treatment of an intertrochanteric, peritrochanteric, or subtrochanteric fracture with plate or nail fixation. If the femur is already completely fractured when you operate, 27244 (or another fracture treatment code) applies — not 27187.

02Does using methylmethacrylate bone cement allow separate billing?

No. Bone cement use is included in the work of 27187. Billing a separate cement or bone void filler code alongside 27187 will trigger an NCCI bundling edit and be denied.

03Is modifier 50 appropriate if both hips are reinforced at the same operative session?

For professional claims, append modifier 50 to a single line. For ASC facility claims, bill two separate lines — one with LT and one with RT — each with one unit of service, per CMS bilateral procedure reporting rules.

04What ICD-10 diagnosis codes support medical necessity for 27187?

Metastatic bone disease (C79.51 for femur), multiple myeloma with bone involvement, and other lytic lesions of the proximal femur are the most common supporting diagnoses. The diagnosis must reflect an impending — not completed — pathologic fracture to align with the prophylactic intent of 27187.

05Can 27187 be billed with a separate E/M on the day of surgery?

Only the day-before pre-operative E/M is included in the global package. A separate E/M on the day of surgery requires modifier 57 if the decision for surgery was made that day. Routine pre-surgical H&P on the operative date is bundled.

06What modifier applies if a second surgeon assists with 27187?

The co-surgeon bills with modifier 62 if two surgeons each perform distinct portions of the procedure. A surgical assistant who is a physician bills with modifier 80; an NP or PA bills with modifier AS.

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 bone defect location (femoral neck vs. proximal femur shaft), whether the femur was intact or incompletely fractured pre-operatively, implant type and size, methylmethacrylate use, laterality, and the oncologic or pathologic indication driving prophylactic fixation. That detail prevents the two most common denials: upcoding flags when fracture status is ambiguous, and medical necessity rejections when the clinical rationale for prophylactic — rather than therapeutic — fixation isn't explicit.

See how Mira captures CPT 27187 documentation