Surgical · Hip

Hindquarter amputation removing the entire lower extremity and the ipsilateral half of the pelvis through the sacroiliac joint and pubic symphysis.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,466.63
Total RVUs: 43.91
Global, days: 90
Region: Hip

Drawn from CMSAAPCAxogenincFindacode

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative report must name the level of disarticulation — sacroiliac joint and pubic symphysis — and confirm hemipelvectomy, not hip disarticulation alone.
Specify laterality (left or right) explicitly in both the operative report and the billing claim.
Pre-op imaging (MRI, CT, or PET) documenting extent of tumor, trauma, or infection justifying hindquarter level rather than a limb-sparing or more distal approach.
Pathology or microbiology report confirming the underlying diagnosis (malignancy, infection, trauma) that drove the operative decision.
Informed consent documentation addressing the magnitude of resection, including pelvic bone removal.
If performed for malignancy, multidisciplinary tumor board note or oncologic consultation supporting hindquarter level resection.
Anesthesia and surgical team composition documented, including any co-surgeon arrangement if modifier 62 is used.

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 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 LT Left side RT Right side AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27290 describes a hindquarter amputation — one of the most extensive ablative procedures in orthopedic surgery. The surgeon removes the entire leg along with the hemipelvis on the same side, disarticulating through the sacroiliac joint posteriorly and the pubic symphysis anteriorly. Indications are narrow: unresectable pelvic or proximal femoral malignancy, massive crush or blast trauma with an unsalvageable limb and pelvis, or refractory life-threatening infection. This is not a hip disarticulation (27295); the pelvic bone goes with the specimen.

The 90-day global period covers all routine postoperative management through day 90, including wound checks, drain removal, and stump evaluation. Anything unrelated to the amputation in that window requires modifier 24. A same-day E/M for a truly separate problem requires modifier 25. Because the procedure is inherently unilateral, modifier 50 is not applicable — document the operative side with LT or RT.

Pre-authorization is standard; most payers require oncologic or traumatologic justification with imaging. Facility setting is virtually universal for this case; ASC billing is rare and payer-specific. The ICD-10-CM diagnosis code must support the severity and necessity — a primary bone sarcoma, Ewing sarcoma, or catastrophic vascular injury is expected. Mismatch between a low-acuity diagnosis and this procedure will trigger medical review.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	23.94
Practice expense RVU	14.88
Malpractice RVU	5.09
Total RVU	43.91
Medicare national rate	$1,466.63
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	$1,466.63
HOPD (APC 5116) Hospital outpatient department	$17,913.59
ASC (PI G2) Ambulatory surgical center (freestanding)	$9,255.83

Common denial reasons

The recurring reasons claims for CPT 27290 get rejected.

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

Diagnosis code does not support hindquarter level — payers expect a high-acuity ICD-10-CM code (e.g., primary bone sarcoma, massive pelvic trauma); a generic or low-acuity code triggers medical necessity review.
Procedure confused with hip disarticulation (27295) — coding the wrong amputation level results in incorrect payment and potential audit exposure.
Missing or inadequate prior authorization — most payers require oncologic or trauma documentation before approval for a procedure of this magnitude.
Laterality not specified on the claim — absence of LT or RT modifier can cause processing errors or rejection by payers requiring anatomical specificity.
Post-op services billed without modifier 24 during the 90-day global period when those services are unrelated to the amputation.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What is the difference between CPT 27290 and CPT 27295?

27290 is a hindquarter amputation — the hemipelvis is removed with the limb. 27295 is a hip disarticulation, where the pelvis stays intact. The operative report must confirm sacroiliac and pubic symphysis disarticulation to support 27290. Using 27295 when the pelvic bone was resected is an under-coding error; the reverse is a potential fraud exposure.

02Does CPT 27290 carry a global period?

Yes — 90-day global. The day before surgery, the day of surgery, and all routine post-op visits through day 90 are bundled. Bill unrelated E/M services during that window with modifier 24. A staged or related return to the OR uses modifier 78; an unrelated procedure uses modifier 79.

03Should I append modifier 50 for this procedure?

No. Bilateral hindquarter amputation is not a recognized clinical scenario. Use LT or RT to identify the operative side. Many payers require laterality on claims for major limb procedures, and omitting it can cause rejection or processing delays.

04Can CPT 27290 be billed with a co-surgeon?

Yes, if medical necessity for two surgeons is documented. Both surgeons bill 27290 with modifier 62. Each surgeon's operative note must describe their distinct role. Some payers require pre-authorization for co-surgery on high-RVU codes — verify before the case.

05What ICD-10-CM codes are typically paired with 27290?

Primary bone malignancies of the pelvis or proximal femur (e.g., C40.20, C41.4), Ewing sarcoma, catastrophic pelvic or proximal femoral trauma, and severe necrotizing infection with pelvic involvement are the typical drivers. The diagnosis must justify why a limb-sparing or more distal amputation was not feasible — document that rationale explicitly.

06Is prior authorization required for CPT 27290?

For virtually all non-emergency cases, yes. Payers expect pre-authorization supported by imaging, pathology or microbiology, and often a second surgical opinion or tumor board note. Emergency trauma cases may bypass prior auth, but post-service documentation of medical necessity must be submitted promptly to avoid denial.

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 level of disarticulation (sacroiliac joint, pubic symphysis), operative laterality, the underlying indication (tumor extent, trauma mechanism, or infection severity), and the surgical approach documented in dictation. It flags operative notes that reference only 'amputation at the hip' without specifying hemipelvectomy — the distinction that separates 27290 from 27295 and prevents a costly level-of-service mismatch on audit.

See how Mira captures CPT 27290 documentation