Excision or curettage of a bone cyst or benign tumor of the femur, with autograft harvest and implantation performed during the same operative session.

Verified May 8, 2026 · 6 sources ↓

Medicare: $766.55
Total RVUs: 22.95
Global, days: 90
Region: Knee

Drawn from CMSNIHFindacode

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative note must identify the exact femoral location of the lesion (proximal, diaphyseal, distal) and its size.
Document the surgical technique: whether excision or curettage was performed, and describe the defect dimensions.
Autograft harvest site must be named explicitly (e.g., iliac crest, local bone window) — do not write 'graft obtained from appropriate site.'
Pathology report confirming benign designation (e.g., unicameral bone cyst, giant cell tumor, enchondroma) must accompany the claim.
Pre-operative imaging (MRI or CT) establishing lesion characterization and size should be in the record.
Document medical necessity narrative explaining why autograft was selected over allograft or synthetic substitute.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 62 Co-surgeons 74 Discontinued post-anesthesia 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 6 cited references ↓

CPT 27357 covers open excision or curettage of a bone cyst or benign tumor located in the femur, combined with autogenous bone grafting — including the work of harvesting the graft from a donor site. This is a single-code solution when the surgeon removes the lesion and fills the resulting defect with the patient's own bone in one operation. The autograft harvest is bundled; do not separately bill a graft-harvest code (e.g., 20900 or 20902) with 27357.

The 90-day global period covers the day-before visit, the procedure itself, and all routine postoperative management through day 90. Any new problem or unrelated service during that window requires modifier 24 (E/M) or 79 (unrelated procedure). If the pathology comes back malignant and staged resection is required during the global, use modifier 58 for the planned staged procedure.

Site of service matters: HOPD and ASC payments differ significantly — see the Site of Service comparison table on this page. Payers increasingly require prior authorization for femoral lesion excision with grafting, and some MACs apply LCD scrutiny to benign tumor designation; operative and pathology documentation must align.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.88
Practice expense RVU	9.76
Malpractice RVU	2.31
Total RVU	22.95
Medicare national rate	$766.55
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	$766.55
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,682.29

Common denial reasons

The recurring reasons claims for CPT 27357 get rejected.

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

Separate billing of bone graft harvest code (20900/20902) alongside 27357 — harvest is already bundled into this code.
Missing or inconsistent pathology report: payer cannot confirm benign diagnosis supports this code.
Lack of prior authorization for open femoral lesion surgery, required by many commercial payers.
Site of service mismatch: procedure billed under office place of service when performed in HOPD or ASC.
Insufficient documentation of lesion location within the femur, triggering a medical necessity flag during audit.

Frequently asked questions

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

01Is the bone graft harvest separately billable with 27357?

No. The autograft harvest is included in 27357 by definition. Separately billing 20900 or 20902 will trigger an NCCI bundling denial with no modifier override available.

02What is the difference between CPT 27355 and 27357?

27355 covers excision or curettage without any graft. 27356 adds an allograft. 27357 is the autograft version and carries the highest RVU of the three because it includes harvesting the patient's own bone.

03Can 27357 be billed bilaterally with modifier 50?

Bilateral femoral lesion excision is rare but not impossible. If performed on both femurs in one session, modifier 50 applies. Document each lesion site separately and expect payer scrutiny — some MACs require individual line items with LT and RT rather than a single line with modifier 50.

04What modifier applies if the surgeon returns to the OR during the 90-day global for a wound complication from this surgery?

Use modifier 78 for an unplanned return to the OR for a complication related to 27357. Modifier 79 would apply only if the return procedure is unrelated to the original femoral surgery.

05Does the 90-day global period include postoperative imaging?

Routine follow-up imaging ordered as part of standard post-op monitoring is generally considered included in the global. Imaging for a new problem or unexpected complication can be billed separately, but document the clinical reason clearly to survive audit.

06If the lesion turns out to be malignant on final pathology and a wider resection is planned, how do you bill the second surgery?

Use modifier 58 on the second procedure code — this signals a staged or related procedure performed during the global period of 27357. Modifier 58 resets the global clock for the new procedure.

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 lesion location within the femur, curettage or excision technique, defect size, autograft harvest site and volume, and graft placement method directly from surgeon dictation. This prevents the most common audit trigger for 27357 — operative notes that omit graft harvest detail, which payers use to question whether the autograft component justifies single-code bundled billing rather than a downcode to 27355.

See how Mira captures CPT 27357 documentation