Open surgical correction of spontaneous hip dislocation (developmental, congenital, or pathological origin) with femoral head replacement into the acetabulum and femoral shaft shortening osteotomy.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,400.50
Total RVUs: 41.93
Global, days: 90
Region: Hip

Drawn from CMSAAPCAbosNIH

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify dislocation type as developmental, congenital, or pathological — traumatic origin disqualifies this code
Confirm femoral shaft shortening was performed; absence of shortening means 27258 is the correct code
Document femoral head repositioning into the acetabulum and any tenotomies performed
Operative note must name the surgical approach (e.g., anterolateral, posterior, medial) — 'standard approach' flags audits
Record pre-op imaging (X-ray, CT, or MRI) confirming spontaneous dislocation and severity
If modifier 22 is used, document specific added complexity, estimated additional time, and why it exceeded typical case expectations

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 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 ↓

27259 covers the open treatment of a spontaneous — not traumatic — hip dislocation, including repositioning of the femoral head into the acetabulum and a femoral shaft shortening procedure. 'Spontaneous' here means developmental, congenital, or pathological origin (e.g., DDH, neuromuscular disease). Traumatic dislocations use a separate code family (27250–27254). The femoral shaft shortening is what distinguishes 27259 from 27258 — if shortening wasn't performed, you're in 27258 territory.

This carries a 90-day global period. All routine post-op care, dressing changes, and related follow-up through day 90 are bundled. Separate E/M visits during that window require modifier 24. If the decision for surgery was made during a same-day E/M, append modifier 57 to the E/M code. Modifier 22 is defensible when operative complexity significantly exceeds the typical case — document the additional time and specific challenges in the operative note.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	22.68
Practice expense RVU	14.42
Malpractice RVU	4.83
Total RVU	41.93
Medicare national rate	$1,400.50
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	$1,400.50
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI J8) Ambulatory surgical center (freestanding)	$2,084.06

Common denial reasons

The recurring reasons claims for CPT 27259 get rejected.

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

Code used for traumatic dislocation — payers expect 27250–27254 for traumatic etiology; mismatch with ICD-10 trauma codes triggers denial
27259 billed when femoral shaft shortening was not performed — 27258 is correct in that scenario
Missing or insufficient documentation of spontaneous/congenital etiology in the operative note
E/M billed same day without modifier 25 or 57, triggering bundling denial
Modifier 22 submitted without supporting narrative explaining additional complexity and time

Frequently asked questions

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

01What separates 27259 from 27258?

Femoral shaft shortening. 27258 covers open treatment of spontaneous hip dislocation with femoral head repositioning. 27259 adds the femoral shaft shortening osteotomy. If shortening wasn't done, bill 27258.

02Can 27259 be used for a traumatic hip dislocation?

No. Traumatic dislocations use 27250–27254. 27259 is strictly for spontaneous dislocations — developmental, congenital (e.g., DDH), or pathological. Using 27259 with a traumatic ICD-10 code (S73.0xx) will trigger a mismatch denial.

03What ICD-10 codes typically pair with 27259?

Expect codes from the congenital or acquired hip dislocation families — Q65.xx (congenital dislocation of hip) or M24.35x (pathological dislocation of hip). A traumatic dislocation code from S73 will not support this procedure code.

04Is modifier 57 ever appropriate with 27259?

Yes, when the decision for surgery was made during an E/M service on the same day as the procedure. Append modifier 57 to the E/M code — not to 27259 — to prevent the E/M from being bundled into the surgical global.

05How does the 90-day global affect post-op billing?

All routine post-op visits, dressing changes, and related care from the day of surgery through day 90 are included in the 27259 payment. Bill unrelated conditions with modifier 24 on the E/M. A staged or unrelated procedure in the global window needs modifier 79; a related return to the OR uses modifier 78.

06Can 27259 be billed bilaterally?

Bilateral cases are rare given the typical patient population, but if both hips are addressed in a single operative session, append modifier 50. Verify individual payer policy — some require LT and RT on separate lines instead of modifier 50 on a single line.

07When is modifier 22 justified for 27259?

When the case significantly exceeded typical complexity — for example, severe acetabular dysplasia, prior failed reduction, or substantial adhesion takedown. Document the specific challenges and additional operative time in the note; payers will request the operative report before paying the upcharge.

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 femoral shaft shortening was performed, femoral head repositioning details, approach name, and any tenotomies. That specificity prevents the most common denial for 27259: upcoding from 27258 or mismatched traumatic ICD-10 codes. If complexity exceeded a typical case, the scribe flags the operative note for a modifier 22 addendum before claim submission.

See how Mira captures CPT 27259 documentation