Fusion · Hip

Open fusion of the hip joint with autograft bone harvested at the same operative session.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,436.24
Total RVUs: 43
Global, days: 90
Region: Hip

Drawn from CMSAAPCAAOSNIH

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Indication for arthrodesis over arthroplasty — document why fusion was chosen (e.g., active infection, failed THA, skeletal immaturity, patient occupation/demand)
Operative note must specify the fusion technique, joint preparation method, and how the femoral head was positioned against the acetabulum
Graft harvest site documented by anatomic location and quantity; confirm autograft source is from the patient (not allograft, which changes the code)
Internal fixation details (blade plate, screws, external fixator) documented even though they are bundled — auditors flag notes that omit hardware description
Pre-op imaging (X-ray, CT, or MRI) supporting degree of joint destruction and diagnosis codes that justify arthrodesis
Laterality clearly stated — left vs. right — to support LT/RT modifier application and prevent site-of-service mismatches

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 52 Reduced services 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

27284 describes an open hip arthrodesis — surgical elimination of hip joint motion by fusing the femoral head to the acetabulum — including harvesting the autologous bone graft used to pack the fusion site. The graft harvest is bundled into this code; do not separately bill a graft-harvest code. This is a salvage procedure most often indicated for end-stage hip pathology in patients who are not candidates for total hip arthroplasty: young high-demand laborers, failed prior THA with severe bone loss, chronic septic arthritis, or post-traumatic deformity requiring structural stability over mobility.

Code 27286 is the companion code when the surgeon also performs a subtrochanteric osteotomy to correct limb alignment at the same session — that additional work justifies the step up. If internal fixation devices are placed to stabilize the fusion construct, that work is considered inherent to 27284 and is not separately reportable. The 90-day global period applies, so any post-op visit, wound check, or hardware monitoring within 90 days of surgery is not separately billable unless it addresses a new, unrelated condition.

Site-of-service selection significantly affects payment. HOPD and ASC payments differ substantially — see the Site of Service comparison table on this page. Because hip arthrodesis is almost exclusively performed in a facility setting, confirm with payers whether inpatient DRG admission is expected; Medicare often routes high-RVU hip procedures through inpatient status, and billing under the PFS in that setting requires attention to site-of-service modifiers and place-of-service codes.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	24.43
Practice expense RVU	13.38
Malpractice RVU	5.19
Total RVU	43
Medicare national rate	$1,436.24
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	$1,436.24
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$9,493.97

Common denial reasons

The recurring reasons claims for CPT 27284 get rejected.

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

Graft harvest billed separately — bone graft procurement is bundled into 27284 and triggers an NCCI edit when coded independently
27286 billed instead of 27284 when no subtrochanteric osteotomy was performed — upcoding risk if operative note does not document the osteotomy
Missing or insufficient medical necessity documentation — payers routinely require prior arthroplasty failure, infection history, or structural imaging before approving hip fusion
Laterality modifier absent — claims processing for bilateral anatomic structures requires LT or RT; absence causes claim suspension or rejection
Global period violations — post-op evaluation and management visits billed without modifier 24 when the visit is for a new, unrelated condition during the 90-day window

Frequently asked questions

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

01Is bone graft harvest separately billable with 27284?

No. Graft harvest is explicitly included in the 27284 descriptor. Billing a separate graft-harvest code will trigger an NCCI bundling edit and the claim will be denied or reduced.

02When do I use 27286 instead of 27284?

Use 27286 only when the surgeon performs a subtrochanteric osteotomy in the same session to reposition the limb. The osteotomy must be documented in the operative note — if it is not there, 27284 is correct.

03What modifiers apply when billing 27284 for a two-surgeon case?

If two surgeons each perform distinct portions of the hip arthrodesis, both bill 27284 with modifier 62 and their individual operative notes must describe their respective roles. A surgical assistant bills with modifier 80 or AS depending on whether the assistant is a physician or non-physician practitioner.

04How is a complication requiring return to the OR handled during the 90-day global?

An unplanned return to the OR for a complication directly related to the hip fusion — such as hardware failure or wound dehiscence at the fusion site — uses modifier 78. An unplanned return for an unrelated procedure (e.g., appendectomy) uses modifier 79.

05Can 27284 and 27286 be billed together on the same hip?

No. They describe the same hip arthrodesis procedure — 27286 is the complete procedure including the osteotomy. Bill one code based on what was actually performed. Billing both is a duplicate claim.

06Does Medicare require inpatient admission for hip arthrodesis?

CMS does not mandate inpatient status by code, but the high RVU and complexity of hip arthrodesis frequently meet inpatient criteria under the Two-Midnight Rule. Check the patient's clinical presentation against Medicare inpatient criteria before defaulting to outpatient facility billing.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures hip arthrodesis dictation by extracting the documented indication for fusion over arthroplasty, the joint preparation and fixation technique, the autograft harvest site and volume, and explicit laterality. That documentation chain prevents the two most common denial triggers: a payer challenge on medical necessity and an NCCI edit firing when graft harvest appears to be a separately billed service.

See how Mira captures CPT 27284 documentation