Closed treatment of a spontaneous (developmental, congenital, or pathological) hip dislocation using abduction, splint, or traction — performed without anesthesia and without manual manipulation.

Verified May 8, 2026 · 6 sources ↓

Medicare: $403.82
Work RVU: 4.17
Global, days: 10
Region: Hip

Drawn from CMSAAPCFindacodeGenhealthAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Explicitly document dislocation etiology as developmental, congenital, or pathological — not traumatic
Record the treatment method used: abduction positioning, splint, or traction (specify which)
Confirm no anesthesia was administered and no manual manipulation was performed
Include imaging interpretation (X-ray or CT) confirming dislocation presence and post-reduction position
Document patient history or clinical findings supporting the spontaneous/pathological diagnosis
Note laterality — left or right hip — to support LT/RT modifier use if applicable

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 6 cited references ↓

27256 covers non-operative management of a spontaneous hip dislocation — the kind arising from developmental, congenital, or pathological causes, not acute trauma. The treating provider repositions or stabilizes the hip through abduction positioning, splinting, or traction. No anesthesia is administered and no hands-on manipulation is performed. If manipulation under anesthesia is required, step up to 27257 instead.

The traumatic vs. spontaneous distinction is the single most important coding decision in this family. Traumatic dislocations code from the 27250–27254 range; spontaneous dislocations code from 27256–27259. Operative notes that don't explicitly document the dislocation etiology — developmental, congenital, or pathological — leave coders without the evidence to defend 27256 over a traumatic-dislocation code. ICD-10 diagnosis selection must match: spontaneous dislocations map to congenital or pathological dislocation categories, not the S73 traumatic codes.

The 010-day global period is short, but still covers the day of surgery and the ten-day follow-up window. Unrelated E/M services during that window need modifier 24. If a subsequent procedure is planned and staged, append modifier 58. A repeat reduction — same dislocation, same physician — takes modifier 76.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (4.17) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (12.09) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	4.17
Practice expense RVU	6.87
Malpractice RVU	1.05
Total RVU	12.09
Medicare national rate	$403.82
Global period	10 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	$403.82
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI G2) Ambulatory surgical center (freestanding)	$135.54

Common denial reasons

The recurring reasons claims for CPT 27256 get rejected.

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

ICD-10 mismatch: traumatic S73 diagnosis codes paired with spontaneous-dislocation CPT 27256
Upcoding flag when anesthesia or manipulation is documented — those elements require 27257 instead
Missing or vague etiology documentation; operative note doesn't specify developmental, congenital, or pathological origin
Duplicate billing without modifier 76 when a repeat reduction is performed same-day by the same physician
Unbundling errors when imaging interpretation is billed separately without supporting separate documentation

Frequently asked questions

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

01What separates 27256 from 27257?

Anesthesia and manipulation. 27256 is used when the provider treats the spontaneous dislocation with abduction, splint, or traction only — no anesthesia, no manipulation. 27257 applies when manipulation requiring anesthesia is performed. If your operative note documents anesthesia or hands-on reduction, 27256 is the wrong code.

02When should I use 27250 instead of 27256?

27250 is for traumatic hip dislocations treated closed without anesthesia. 27256 is reserved for spontaneous dislocations — developmental, congenital, or pathological. The etiology documented in the operative note and the ICD-10 diagnosis code must align with whichever you bill.

03Is 27256 appropriate for prosthetic hip dislocation?

No. Prosthetic hip dislocation has its own code set. 27256 is limited to native-joint spontaneous dislocations. Billing 27256 for a dislocated THA will likely trigger a denial or audit flag.

04What is the global period for 27256, and what does it include?

27256 carries a 10-day global period. That covers the day of the procedure plus the 10 subsequent days of routine follow-up. E/M visits unrelated to the hip dislocation during that window require modifier 24 to be separately billable.

05Can 27256 be billed bilaterally?

Yes, if both hips are treated in the same session, append modifier 50. Document the indication and treatment method for each hip separately in the operative note.

06If the dislocation recurs and requires a second reduction, what modifier applies?

Use modifier 76 if the same physician repeats the procedure. Use modifier 77 if a different physician performs the repeat reduction. Both require documentation explaining why the repeat procedure was necessary.

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 dislocation type (developmental, congenital, or pathological), treatment method (abduction, splint, or traction), absence of anesthesia, and absence of manual manipulation directly from dictation. This prevents the most common audit flag for 27256: an operative note that documents manipulation or anesthesia while billing the no-anesthesia/no-manipulation code, and stops ICD-10 mismatches between traumatic diagnosis codes and a spontaneous-dislocation procedure code.

See how Mira captures CPT 27256 documentation