Open surgical treatment of a traumatic hip dislocation combined with fractures of the acetabular wall and femoral head, with or without internal or external fixation.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,157.01
Total RVUs: 34.64
Global, days: 90
Region: Hip

Drawn from CMSAAPCGenhealthAbosNIH

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Explicit documentation of traumatic mechanism — not spontaneous or developmental dislocation
Confirmation of both acetabular wall fracture AND femoral head fracture in operative or pre-op imaging report
Operative note naming the surgical approach (e.g., posterior Kocher-Langenbeck, anterior Smith-Petersen) — 'standard approach' flags audits
Description of reduction technique, fracture repair method, and fixation hardware used (type, size, number of implants) if fixation was performed
Intraoperative or post-reduction fluoroscopy or imaging findings confirming joint reduction and fixation position
ICD-10-CM codes capturing traumatic hip dislocation plus distinct acetabular wall and femoral head fracture — all three components required for code justification

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 57 Decision for surgery 58 Staged or related 62 Co-surgeons 73 Discontinued pre-anesthesia 74 Discontinued post-anesthesia 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 7 cited references ↓

27254 covers open reduction of a traumatic hip dislocation where the surgeon also addresses concurrent acetabular wall and femoral head fractures. The procedure involves direct surgical exposure of the hip joint, manual or instrument-assisted reduction, fracture repair, and — when indicated — stabilization with screws, plates, or external fixation hardware. This is a high-complexity case distinct from 27253 (open dislocation treatment without internal fixation) and from isolated acetabular fracture codes; the defining feature is the combination of dislocation plus fractures of both the acetabular wall and femoral head.

27254 carries a 90-day global period. That window covers the pre-op day-of-or-before visit, the operative session, and all routine post-op care through day 90 — including wound checks, implant monitoring visits, and suture removal. Any unrelated E/M or procedure billed inside the global requires modifier 24 or 79 respectively. Complications requiring a return to the OR for a related issue bill with modifier 78; an unrelated OR procedure in the global uses modifier 79.

This is a hospital-based procedure — the research brief does not list it as routinely performed in ASC settings, consistent with its clinical complexity. Coders should confirm accurate ICD-10-CM coding that reflects the dislocation plus the specific fracture pattern (acetabular wall and femoral head); missing or mismatched fracture diagnosis codes are a primary driver of payer review.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	18.47
Practice expense RVU	12.24
Malpractice RVU	3.93
Total RVU	34.64
Medicare national rate	$1,157.01
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	$1,157.01
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI G2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 27254 get rejected.

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

ICD-10-CM diagnosis codes document dislocation only, without supporting fracture codes for both acetabular wall and femoral head
Code selected when only one fracture component (acetabular wall OR femoral head) is present — 27253 or acetabular fracture codes may be more appropriate
Upcoding flag when operative note does not document open reduction — if a closed reduction was attempted and successful, open codes are not supported
Global period conflict — post-op visits or related procedures billed without required modifiers (24, 78) inside the 90-day window
Missing or vague operative note regarding fixation — 27254 covers cases with or without fixation, but the note must state whether fixation was or was not used and why

Frequently asked questions

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

01What separates 27254 from 27253?

27253 is open treatment of traumatic hip dislocation without internal fixation and without the combined acetabular wall and femoral head fracture requirement. Use 27254 when both the acetabular wall fracture and femoral head fracture are present and treated openly, regardless of whether fixation hardware is placed.

02Can 27254 be billed with acetabular fracture repair codes on the same day?

Generally no. 27254 already encompasses treatment of the acetabular wall fracture component. Separately billing an acetabular fracture repair code same-day creates an NCCI bundling conflict. Review current PTP edits before appending modifier 59 or XS — documentation must clearly support distinct, separate procedures at anatomically separate sites.

03What modifier applies if the surgeon returns to the OR during the 90-day global to address hardware failure at the same hip?

Modifier 78 — unplanned return to the OR for a complication related to the original procedure. Do not use 79 here; 79 is for unrelated procedures during the global period.

04Does 27254 require inpatient billing, or can it be billed in an ASC?

27254 is a high-complexity trauma procedure typically performed in a hospital OR. CMS assigns it an ASC payment rate, but clinical appropriateness for ASC setting is rare. Most payers expect this case in an inpatient or hospital outpatient setting; confirm payer policy before scheduling outside a hospital.

05How should a same-day E/M be handled if the surgeon evaluates the patient in the ED and then immediately takes them to the OR?

An E/M on the same date as a major surgical procedure with a 90-day global is subject to bundling. If the E/M was a separate, distinct decision for surgery, append modifier 57 to the E/M code. Without modifier 57, the E/M bundles into 27254 and will deny.

06Is an assistant surgeon billable on 27254?

Yes. Open hip dislocation with combined fracture repair is a procedure where an assistant surgeon is clinically justified. Bill the assistant with modifier 80 (MD assistant) or AS (PA/NP/CRNA assistant). Medicare pays 16% of the primary surgeon's fee for an MD assistant; confirm payer-specific assistant allowances.

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 traumatic mechanism, the specific fracture pattern (acetabular wall and femoral head), the surgical approach by name, reduction technique, and fixation hardware details directly from dictation. This prevents the most common 27254 denial: an operative note that documents the dislocation but omits clear documentation of both fracture components, which triggers downcoding to 27253 or an outright rejection on ICD-10 mismatch.

See how Mira captures CPT 27254 documentation