Surgical removal of the entire lower extremity by disarticulating through the hip joint, separating the femur and surrounding soft tissues at the acetabulum.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $1,146.99
- Total RVUs
- 34.34
- Global, days
- 90
- Region
- Hip
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 6 cited references ↓
- Clearly stated surgical indication — malignancy, infection, trauma, or vascular — with supporting preoperative workup documented in the chart
- Confirmation that disarticulation occurred at the hip joint level, not through the femoral shaft (which would map to a different code)
- Description of neurovascular management: named vessels ligated, nerve handling technique to address post-amputation neuroma risk
- Muscle and soft-tissue handling details including flap design and closure method
- Attending surgeon attestation if a surgical oncologist, vascular, or plastic surgeon participated and co-billed (modifier 62 or 80 as applicable)
- Pathology submission documentation if performed for malignancy — required by most payers and standard of care
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 6 cited references ↓
CPT 27295 describes hip disarticulation — complete removal of the lower extremity at the hip joint. The surgeon divides the muscles, ligaments, and neurovascular structures circumferentially around the hip, disarticulates the femoral head from the acetabulum, and closes the resulting soft-tissue envelope. No femoral bone is transected; the entire femur exits with the limb. Indications include aggressive soft-tissue or bone malignancy, severe traumatic injury with non-reconstructible vascular compromise, life-threatening infection (e.g., necrotizing fasciitis, refractory osteomyelitis), or failed limb-sparing attempts.
This is a 90-day global procedure. All routine post-operative visits, wound checks, and stitch removals through day 90 are bundled. Any separately billable service during the global window — for an unrelated condition or a distinct new problem — requires modifier 24 (E/M) or modifier 79 (unrelated procedure). A planned staged return to the OR for a related complication uses modifier 78. Document that distinction clearly in the operative note or it will be denied.
Hip disarticulation is almost exclusively performed in a hospital inpatient setting given the magnitude of the procedure, fluid shifts, and post-operative monitoring requirements. The ASC payment rate exists in the fee schedule but performing this at an ASC is clinically uncommon; payers will scrutinize site-of-service coding accordingly. The operating surgeon must document the specific indication, level confirmed intraoperatively, tissue management (vascular ligation, nerve management to reduce neuroma risk), and closure technique.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 19.17 |
| Practice expense RVU | 10.93 |
| Malpractice RVU | 4.24 |
| Total RVU | 34.34 |
| Medicare national rate | $1,146.99 |
| 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 | $1,146.99 |
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 27295 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Level mismatch: operative note does not clearly confirm joint-level disarticulation vs. transfemoral amputation, triggering a code edit or downcoding to 27590
- Global period conflict: post-operative E/M claims submitted without modifier 24 are auto-denied when the date falls within the 90-day global window
- Medical necessity not established: missing preoperative imaging, oncology notes, or infectious disease workup that substantiates why limb-sparing was not viable
- Site-of-service mismatch: claim billed with a facility code inconsistent with the inpatient setting documented in the operative report
- Missing co-surgeon documentation: modifier 62 billed without both surgeons' operative notes or without payer pre-authorization for co-surgeon reimbursement
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What is the difference between CPT 27295 and CPT 27590?
02Can 27295 be billed with a second surgeon using modifier 62?
03What modifier applies if the patient returns to the OR during the global period for wound dehiscence?
04Does the 90-day global period cover physical therapy and prosthetic consultations?
05Is modifier 22 ever appropriate for 27295?
06What ICD-10 diagnosis codes typically support medical necessity for 27295?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02aapc.comhttps://www.aapc.com/codes/cpt-codes/27295
- 03aapc.comhttps://www.aapc.com/codes/cpt-codes-range/27290-27295/
- 04genhealth.aihttps://genhealth.ai/code/cpt4/27295-disarticulation-of-hip
- 05axogeninc.comhttps://www.axogeninc.com/wp-content/uploads/2025/04/2025-Neurectomy-Post-Amputation-Coding-Guide.pdf
- 06cms.govhttps://www.cms.gov/files/document/medicare-ncci-policy-manual-2024-chapter-5.pdf
Mira AI Scribe
Mira's AI scribe captures the joint level of disarticulation, the surgical indication, vascular ligation and nerve management steps, flap design, and closure technique directly from dictation. This prevents the most common audit flag on 27295 — an operative note that fails to distinguish hip joint disarticulation from transfemoral amputation — and supports medical necessity documentation for payers requiring evidence that limb-sparing alternatives were considered and rejected.
See how Mira captures CPT 27295 documentation