Open arthrodesis of the hip joint performed via a subtrochanteric osteotomy approach, fusing the hip in a functional position while simultaneously correcting deformity at the subtrochanteric level.

Verified May 8, 2026 · 5 sources ↓

Medicare: $1,480.66
Total RVUs: 44.33
Global, days: 90
Region: Hip

Drawn from CMSAAOS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Operative note must name the specific surgical approach and confirm the osteotomy was performed at the subtrochanteric level
Document the final fusion position: degrees of flexion, abduction, and rotation selected and rationale for those angles
Laterality must be explicitly stated in both the operative note and on the claim (LT or RT)
Indications for arthrodesis over arthroplasty must be documented — e.g., active infection, young high-demand patient, failed prior THA, avascular necrosis with insufficient bone stock
If modifier 22 is appended, the operative note must quantify the additional work: unusual anatomy, prior hardware removal, prolonged operative time, or severe deformity
Post-op imaging confirming osteotomy site and fusion construct should be present 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 51 Multiple procedures 57 Decision for surgery 58 Staged or related 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 5 cited references ↓

CPT 27286 describes open surgical fusion of the hip joint accomplished through a subtrochanteric osteotomy. The osteotomy allows the surgeon to position the femur in the optimal functional alignment — typically slight abduction, neutral rotation, and mild flexion — before completing the arthrodesis. This approach is selected when deformity, prior hardware, or bony anatomy makes a straightforward hip fusion technically impractical without the added osteotomy step.

The procedure carries a 90-day global period. All routine post-op care, wound checks, and hardware monitoring visits through day 90 are bundled. Unrelated E/M services billed in that window require modifier 24; a decision-for-surgery visit on the day before or day of the procedure requires modifier 57.

Because the subtrochanteric osteotomy is integral to the approach and not a separately billable step, do not stack an additional osteotomy code alongside 27286. Document laterality explicitly — payers will deny or suspend claims that omit LT or RT on a unilateral hip procedure. Increased procedural complexity (severe deformity, prior failed arthroplasty, revision anatomy) should be captured with modifier 22, backed by a detailed operative note explaining the added work.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	24.54
Practice expense RVU	14.57
Malpractice RVU	5.22
Total RVU	44.33
Medicare national rate	$1,480.66
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	$1,480.66
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 27286 get rejected.

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

Missing laterality modifier (LT/RT) — payers auto-suspend or deny unilateral hip procedures billed without a side designation
Bundling conflict when a separate osteotomy code is billed alongside 27286 — the subtrochanteric osteotomy is integral to this code's descriptor
Modifier 22 appended without supporting documentation explaining substantially increased operative complexity
Medical necessity not established — insufficient documentation of why arthrodesis was selected over total hip arthroplasty
E/M services billed during the 90-day global period without modifier 24 or 25, triggering automatic denial as bundled post-op care

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Can I separately bill a subtrochanteric osteotomy code in addition to 27286?

No. The subtrochanteric osteotomy is part of the procedure descriptor for 27286. Billing a standalone osteotomy code alongside it is an NCCI bundling violation and will be denied.

02Does the 90-day global period reset if the patient returns for hardware revision?

It depends. A staged or related return procedure by the same surgeon uses modifier 58 and resets the global clock. An unplanned return to the OR for a complication related to the original fusion uses modifier 78 and does not reset the global. An unrelated procedure uses modifier 79.

03When is modifier 22 appropriate for 27286?

Append modifier 22 when operative complexity is substantially greater than typical — prior failed THA with hardware removal, severe angular deformity requiring extended osteotomy work, or markedly prolonged OR time. The operative note must explicitly describe what made the case harder, not just state 'complex.'

04Is 27286 appropriate for a revision hip fusion after a failed arthroplasty?

If the prior implant was fully removed and the surgeon is performing a new arthrodesis via subtrochanteric osteotomy, 27286 can be appropriate. Document the prior hardware removal separately if it constitutes a distinct, significant service, and evaluate NCCI edits for any removal codes billed same-day.

05Which ICD-10 diagnosis codes support medical necessity for hip arthrodesis?

Commonly paired diagnoses include post-traumatic hip OA (M16.5x), avascular necrosis of the femoral head (M87.05x), sequelae of septic arthritis or periprosthetic infection, and certain high-demand young patients with end-stage hip pathology. Payer LCDs vary — confirm active coverage policies for the specific payer before submission.

06Is 27286 performed in an ASC setting?

CMS has assigned an ASC payment rate for 27286, but this is a major open reconstructive procedure most commonly performed in a hospital inpatient or HOPD setting. Verify ASC facility privileges and payer authorization requirements before scheduling outside a hospital.

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 osteotomy level (subtrochanteric), final fusion position in degrees, laterality, and the clinical rationale for arthrodesis from dictation — preventing the two most common denials: missing side designation and unsupported medical necessity. It also flags if modifier 22 language is present in the dictation so coders can attach supporting documentation before submission.

See how Mira captures CPT 27286 documentation