Closed reduction of a dislocated hip in a patient with prior total hip arthroplasty, performed without anesthesia.

Verified May 8, 2026 · 7 sources ↓

Medicare: $493.33
Work RVU: 5.11
Global, days: 90
Region: Hip

Drawn from CMSAAPCNIHFindacode

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Confirm prior total hip arthroplasty in the history — note laterality, implant type if known, and date of original procedure.
Document imaging (X-ray or fluoroscopy) confirming dislocation before the procedure and successful reduction after.
Record that no anesthesia (regional or general) was administered; note any analgesic or sedation used, which must fall below the threshold for 27266.
Specify the reduction technique used: traction direction, patient positioning, and number of attempts.
Document post-reduction neurovascular status and plan for follow-up imaging or further workup.

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 7 cited references ↓

CPT 27265 covers manual realignment of a dislocated hip joint in a patient who has previously undergone total hip arthroplasty (THA). The physician uses traction and manipulation to guide the femoral head back into the acetabular component without making an incision and without regional or general anesthesia. Imaging — typically fluoroscopy or plain radiograph — confirms reduction before and after the maneuver.

This code is post-arthroplasty specific. Do not use 27265 for traumatic native-hip dislocations or spontaneous/developmental dislocations; those map to 27250–27259. If the reduction requires regional or general anesthesia, bill 27266 instead. The distinction between 27265 and 27266 is the anesthesia level — not the technique.

The 90-day global period attaches to 27265. Any E/M visit or service during that window that is unrelated to the dislocation requires modifier 24. If the hip dislocates again within the global and the same physician performs a repeat reduction, append modifier 76. A recurrent dislocation addressed by a different physician within the global requires modifier 77.

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 (5.11) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (14.77) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.11
Practice expense RVU	8.43
Malpractice RVU	1.23
Total RVU	14.77
Medicare national rate	$493.33
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	$493.33
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI A2) Ambulatory surgical center (freestanding)	$135.54

Common denial reasons

The recurring reasons claims for CPT 27265 get rejected.

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

Using 27265 when anesthesia was administered — should be 27266 if regional or general anesthesia was required.
Missing or mismatched ICD-10 diagnosis: post-arthroplasty dislocation requires a complication-of-prosthesis code (T84.02x-) paired with the correct laterality character; a traumatic or pathologic dislocation code will not support this CPT.
Billing 27265 for a native hip dislocation with no prior arthroplasty history — code selection does not match the documented clinical scenario.
Repeat reduction billed without modifier 76 or 77 when performed within the 90-day global period of the original reduction.

Frequently asked questions

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

01What is the difference between 27265 and 27266?

The only distinction is anesthesia level. 27265 is closed reduction without anesthesia; 27266 requires regional or general anesthesia. Both apply exclusively to post-arthroplasty dislocations.

02Which ICD-10 codes support 27265?

Use a T84.02x- code (dislocation of internal joint prosthesis, hip) with the appropriate seventh character for initial encounter, subsequent encounter, or sequela. The laterality character is required. A traumatic or pathologic dislocation code does not support this CPT.

03Can 27265 be billed if the patient has a hip hemiarthroplasty rather than a total hip replacement?

The code descriptor specifies post hip arthroplasty dislocation broadly, which includes hemiarthroplasty. Document the implant type clearly; payer edits occasionally flag claims where the diagnosis code implies a partial versus total replacement.

04What modifier applies if the same hip dislocates again within the 90-day global?

Append modifier 76 if the same physician performs the repeat reduction, or modifier 77 if a different physician performs it. Both bypass the global period edit for the repeat service.

05Is a pre-procedure imaging code separately billable on the same date?

Yes — imaging performed to confirm dislocation before reduction (X-ray or fluoroscopy) is separately reportable with the appropriate radiology code. The reduction code does not bundle diagnostic imaging under its global period on the date of service itself.

06Does 27265 apply in a SNF setting?

CMS SNF consolidated billing includes 27265 in the Part B SNF enforcement list. In most cases, the SNF receives a consolidated payment and bills the MAC directly; the treating physician bills separately under Part B. Confirm with your MAC if the service was provided during an active SNF stay.

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 arthroplasty history (laterality, prior procedure), the absence of regional or general anesthesia, reduction technique and traction applied, pre- and post-reduction imaging results, and post-procedure neurovascular exam. That detail locks in the 27265 vs. 27266 distinction and prevents denials tied to missing anesthesia documentation or an unsupported ICD-10 complication code.

See how Mira captures CPT 27265 documentation