Closed reduction of a spontaneous hip dislocation (developmental, congenital, or pathological) using manipulation under anesthesia, with abduction, splinting, or traction as indicated.

Verified May 8, 2026 · 6 sources ↓

Medicare: $329.67
Work RVU: 5.25
Global, days: 10
Region: Hip

Drawn from CMSAAPCFindacodeEmedny

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify dislocation type as spontaneous, developmental, congenital, or pathological — not traumatic
Document that anesthesia was administered and confirm manipulation was performed
Record technique used: abduction, splinting, traction, or combination
Confirm the ICD-10 diagnosis code matches the documented etiology (congenital, pathological, developmental)
Note pre- and post-reduction imaging findings if obtained
Document the treating physician's involvement when anesthesia is provided by a separate provider

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 57 Decision for surgery 58 Staged or related 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 6 cited references ↓

CPT 27257 covers closed treatment of a spontaneous hip dislocation — developmental, congenital, or pathological in origin — when the reduction requires manipulation under anesthesia. The surgeon repositions the femoral head into the acetabulum using abduction, a splint, or traction rather than open surgical exposure. Anesthesia is the key distinguishing factor between 27257 and its sibling code 27256, which covers the same dislocation type managed without anesthesia or manipulation.

This code applies strictly to spontaneous (non-traumatic) hip dislocations. Traumatic hip dislocations requiring anesthesia map to 27252. Post-arthroplasty dislocations are a separate family entirely (27265–27266). Miscoding the dislocation type is the single most common audit trigger for this family of codes — the operative note and diagnosis must align on etiology.

The global period is 10 days. Routine follow-up within that window is included. If a complication drives an unplanned return to the OR for a related procedure during the global, append modifier 78. For a staged or planned subsequent procedure, use modifier 58. Fluoroscopic guidance used during the reduction is generally considered integral to the procedure and is not separately billable under NCCI policy.

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 (5.25) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (9.87) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.25
Practice expense RVU	3.5
Malpractice RVU	1.12
Total RVU	9.87
Medicare national rate	$329.67
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	$329.67
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 27257 get rejected.

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

Dislocation etiology mismatch — traumatic ICD-10 diagnosis paired with spontaneous treatment code 27257 instead of 27252
Post-arthroplasty dislocation billed under 27257 instead of 27265/27266
Fluoroscopy (76000) billed separately when it is integral to the reduction under NCCI policy
Missing documentation of anesthesia use, causing downcoding to 27256
Global period conflicts when follow-up E/M lacks modifier 24 for unrelated visits within the 10-day window

Frequently asked questions

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

01What separates 27257 from 27256?

Anesthesia and manipulation. Use 27256 when the surgeon reduces a spontaneous hip dislocation without anesthesia and without manipulation. Use 27257 when anesthesia is required to achieve reduction with manipulation. The dislocation etiology — spontaneous, developmental, congenital, or pathological — is the same for both codes.

02Can I bill 27257 for a traumatic hip dislocation requiring anesthesia?

No. Traumatic hip dislocations requiring anesthesia map to 27252. The 27257 family is reserved for spontaneous dislocations (developmental, congenital, or pathological). Using 27257 with a traumatic ICD-10 code is a guaranteed mismatch denial.

03What code applies when a total hip arthroplasty patient dislocates and needs anesthesia for reduction?

Use 27266 for closed treatment of a post-arthroplasty hip dislocation requiring regional or general anesthesia. Do not use 27257 — that code is specific to spontaneous (non-prosthetic) dislocations.

04Can fluoroscopy be billed separately with 27257?

No. Per CMS NCCI 2026 policy, radiologic guidance used during a closed reduction procedure is integral to the reduction and is not separately reportable. If a distinct imaging procedure is performed for a separate indication on the same date, bill that separately with modifier 59 or XS, but intraoperative fluoroscopy for the reduction itself is bundled.

05What modifier applies if the patient returns to the OR during the global period for a related complication?

Modifier 78 — unplanned return to the operating room for a related procedure during the global period. The 10-day global for 27257 is short, but complications like re-dislocation requiring repeat reduction under anesthesia would fall under 78. For a planned staged procedure, use modifier 58 instead.

06Is 27257 billable bilaterally?

Bilateral hip dislocation is rare but possible, particularly in congenital presentations. If both hips are reduced in the same session, append modifier 50 and bill on a single line. Confirm payer policy — some commercial payers require separate lines with LT and RT instead.

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 etiology (developmental, congenital, or pathological), confirmation that manipulation was performed, the specific reduction technique (abduction, splint, or traction), and anesthesia type from the operative dictation. This prevents the most common denial for this code family: a mismatch between a traumatic or post-arthroplasty ICD-10 diagnosis and a spontaneous-dislocation procedure code.

See how Mira captures CPT 27257 documentation