Surgical · Hip

Open reduction of a spontaneous (developmental, congenital, or pathological) hip dislocation with replacement of the femoral head into the acetabulum, including adductor tenotomy when performed.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,019.06
Total RVUs: 30.51
Global, days: 90
Region: Hip

Drawn from CMSEmednyAbosNIH

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Explicitly state the etiology of the dislocation (developmental, congenital, or pathological) — 'spontaneous' alone is insufficient for audit defense.
Operative note must confirm open approach with direct visualization and manual replacement of the femoral head into the acetabulum.
Document whether adductor tenotomy was performed; it is bundled into 27258 but its presence confirms code accuracy over 27257.
Confirm absence of femoral shaft shortening — if shortening was performed, 27259 applies and the operative note must reflect that distinction.
Record laterality (left, right) explicitly in the operative report and on the claim.
Pre-op imaging (X-ray or MRI) confirming dislocation and its non-traumatic nature should be in the record.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 62 Co-surgeons 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 ↓

CPT 27258 covers open surgical treatment of a spontaneous hip dislocation — developmental, congenital, or pathological in origin — as distinguished from traumatic dislocations handled under codes 27253–27254. The surgeon opens the joint, repositions the femoral head into the acetabulum, and performs an adductor tenotomy as part of the same operative session. The tenotomy is bundled into 27258 and is not separately billable. When femoral shaft shortening is also required, step up to 27259 instead.

This code carries a 90-day global period. All routine post-op office visits, dressing changes, and stitch removals through day 90 are included in the global package. Unrelated E&M services during that window require modifier 24; a significant, separately identifiable E&M on the day of surgery requires modifier 25. The etiology distinction — spontaneous versus traumatic — drives code selection here and must be explicit in the operative and clinical documentation.

Site-of-service matters for reimbursement. The procedure is almost always performed in a hospital or ASC setting. If the patient also requires femoral shaft shortening at the same operative session, 27259 is the correct code, not 27258 with a separate tenotomy or shortening code bolted on. Bilateral cases (rare given the etiology) would use 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	11.38
Malpractice RVU	3.35
Total RVU	30.51
Medicare national rate	$1,019.06
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	$1,019.06
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI G2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 27258 get rejected.

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

Wrong code family selected — traumatic dislocation billed under 27258 instead of 27253 or 27254, triggering a diagnosis-to-code mismatch denial.
Tenotomy billed separately (e.g., 27306) on the same claim — it is bundled into 27258 and will be denied under NCCI bundling rules.
Femoral shaft shortening performed but 27258 billed instead of 27259, leading to a downcoding or medical-record-request denial.
Missing or vague etiology documentation — operative notes that do not distinguish spontaneous from traumatic dislocation fail medical necessity review.
Routine post-op E&M visits billed without modifier 24 during the 90-day global period.

Frequently asked questions

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

01What is the difference between CPT 27258 and 27253?

27253 is for open treatment of a traumatic hip dislocation. 27258 is for spontaneous dislocations — developmental, congenital, or pathological. The etiology must be documented clearly; using the wrong code is a top denial trigger for this code family.

02Is the adductor tenotomy separately billable when performed with 27258?

No. The tenotomy is bundled into 27258. Billing a separate tenotomy code (e.g., 27306) on the same claim will be denied under NCCI bundling rules.

03When should I use 27259 instead of 27258?

Use 27259 when femoral shaft shortening is performed at the same operative session. 27258 does not include shortening. The operative note must document the shortening procedure to support 27259.

04What global period applies to 27258, and what does it cover?

27258 has a 90-day global period. That covers the surgery, the day-before pre-op visit, and all routine post-op care through day 90. Unrelated office visits in that window need modifier 24. A significant, separately identifiable E&M on the day of surgery needs modifier 25.

05Can 27258 be billed bilaterally?

Bilateral spontaneous hip dislocation is rare, but if both hips are treated open at the same session, append modifier 50. Document the indication and operative findings for each side separately.

06Does a same-day E&M require modifier 25 with 27258?

Yes — if you're billing an E&M on the same date as 27258, it must be significant and separately identifiable from the decision to perform the procedure, and modifier 25 is required. The fact that the patient is new to the practice is not sufficient justification on its own per NCCI policy.

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), confirms the open approach with femoral head repositioning into the acetabulum, and flags whether adductor tenotomy and/or femoral shaft shortening were performed. That last distinction is the difference between 27258 and 27259 — catching it at dictation prevents a post-bill downcoding request or a medical records audit.

See how Mira captures CPT 27258 documentation