Radical resection of a tumor involving the femur or knee, including bone and surrounding soft tissue as required for oncologic margins.
Verified May 8, 2026 · 7 sources ↓
- Medicare
- $1,837.05
- Total RVUs
- 55
- Global, days
- 90
- Region
- Knee
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 7 cited references ↓
- Operative note must specify the anatomic location within the femur or knee (distal femur, proximal tibia, patella) and confirm radical/wide margin intent
- Preoperative imaging reports (MRI, CT, bone scan) referenced in the operative note to establish oncologic extent and surgical planning basis
- Pathology report confirming tumor type and margin status — required to substantiate malignant or aggressive-benign diagnosis on the claim
- ICD-10 diagnosis code must match the confirmed tumor type: primary malignancy, metastatic lesion, or benign aggressive tumor as documented by pathology
- If reconstruction was performed at the same operative session, document each component separately to support any additional codes billed alongside 27365
- Informed consent documentation should reference the oncologic nature of the resection and limb-salvage vs. amputation decision if applicable
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 7 cited references ↓
CPT 27365 covers radical resection of a tumor at the femur or knee — a high-complexity procedure performed almost exclusively by orthopedic oncologists or fellowship-trained orthopedic surgeons. 'Radical' means the resection extends beyond the tumor capsule to achieve wide or radical margins, distinguishing it from simple excision or curettage codes. The procedure may include distal femur, proximal tibia, or patella involvement and typically requires intraoperative frozen-section margin assessment.
The 90-day global period governs everything: the day-before visit, the surgery itself, and all routine post-op care through day 90. Unrelated E/M visits in that window need modifier 24. A planned staged procedure — such as reconstruction after the oncologic resection — bills with modifier 58. An unplanned return for a related complication uses modifier 78.
Diagnosis coding matters more here than on most orthopedic codes. Payers scrutinize ICD-10 alignment closely: primary malignant bone tumors (C40.2x), secondary/metastatic lesions (C79.51), and benign aggressive tumors each carry different authorization and medical-necessity thresholds. Preoperative imaging — MRI with and without contrast, CT, and bone scan — should be documented in the operative note as the basis for surgical planning.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 31.4 |
| Practice expense RVU | 16.89 |
| Malpractice RVU | 6.71 |
| Total RVU | 55 |
| Medicare national rate | $1,837.05 |
| 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 | $1,837.05 |
HOPD (APC 5113) Hospital outpatient department | $3,342.87 |
ASC (PI G2) Ambulatory surgical center (freestanding) | $1,644.87 |
Common denial reasons
The recurring reasons claims for CPT 27365 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- ICD-10 mismatch: diagnosis code does not reflect confirmed pathology, triggering medical-necessity denial
- Insufficient operative note detail — notes that describe 'tumor removal' without specifying radical/wide margins are downcoded or denied
- Missing or incomplete preoperative imaging documentation used to justify extent of resection
- Prior authorization not obtained or obtained under wrong diagnosis before pathology confirmation
- Bundling denial when reconstruction codes are billed without adequate documentation distinguishing the oncologic resection from the reconstructive component
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 7 cited references ↓
01What distinguishes 27365 from lower-level femur/knee tumor excision codes?
02Can 27365 and a reconstruction code be billed together on the same date?
03Which ICD-10 codes most commonly pair with 27365?
04Is prior authorization typically required for 27365?
05How does the 90-day global period interact with oncology follow-up visits after 27365?
06When does modifier 22 apply to 27365?
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/27365
- 03mdclarity.comhttps://www.mdclarity.com/cpt-code/27365
- 04genhealth.aihttps://genhealth.ai/code/cpt4/27365-radical-resection-of-tumor-femur-or-knee
- 05findacode.comhttps://www.findacode.com/cpt/27365-cpt-code.html
- 06vsac.nlm.nih.govhttps://vsac.nlm.nih.gov/context/cs/codesystem/CPT/version/2021/code/27365/info
- 07acgme.orghttps://www.acgme.org/globalassets/pfassets/programresources/270_caselogguidelines_musculoskeletaloncology.pdf
Mira AI Scribe
Mira's AI scribe captures the tumor location (distal femur, proximal tibia, patella), margin strategy (radical vs. wide), resection dimensions, intraoperative frozen-section results, and any immediate reconstructive steps from the surgeon's dictation. That detail prevents the two most common denials for 27365: operative notes too vague to support radical resection billing, and ICD-10 codes that don't align with confirmed pathology.
See how Mira captures CPT 27365 documentation