Surgical · Other

Transfemoral (above-knee) amputation through the femur at any level, with immediate prosthetic fitting and application of the first cast.

Verified May 8, 2026 · 6 sources ↓

Medicare: $889.13
Total RVUs: 26.62
Global, days: 90
Region: Other

Drawn from CMSAAOSNIH

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify the level of amputation on the femur (proximal, mid-shaft, distal third, etc.)
Confirm that immediate prosthetic fitting was performed and the first cast was applied intraoperatively
Document the indication — underlying diagnosis driving amputation (e.g., vascular disease, trauma, malignancy, infection)
Record the surgical technique: myodesis or myoplasty closure, skin flap design, and method of bone transection
Note any intraoperative cultures, pathology specimens, or vascular assessment findings if applicable
Operative note must clearly support immediate fitting — generic language like 'standard amputation performed' will not establish 27591 over 27590

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 50 Bilateral procedure 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 AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27591 covers amputation through the femur at any level when the surgeon also applies an immediate postoperative prosthetic fitting and the first cast at the time of surgery. That fitting component is what distinguishes 27591 from 27590 (no immediate fitting) and 27592 (open/guillotine technique). The goal of the immediate fitting approach is to begin early weight-bearing rehabilitation and optimize functional outcomes for the patient.

The 90-day global period means all routine postoperative care — wound checks, cast changes, suture removal, and standard follow-up visits — is bundled into the surgical fee from the day before surgery through day 90. Any visit for an unrelated condition during that window needs modifier 24 (E/M) or modifier 79 (unrelated procedure). A planned staged procedure on the same extremity, such as revision or definitive prosthetic socket fitting if coded separately, would use modifier 58.

For facility billing, this procedure maps to OPPS APC 5116 in the hospital outpatient setting. The AAOS cross-reference places 27591 alongside 27594 as the comparable procedure code group, relevant for physician self-referral compliance under the Stark Law code list.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	13.59
Practice expense RVU	10.12
Malpractice RVU	2.91
Total RVU	26.62
Medicare national rate	$889.13
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	$889.13
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 27591 get rejected.

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

Operative note documents amputation but does not confirm immediate prosthetic fitting or first cast application, causing downcode to 27590
Missing or insufficient diagnosis code — payers require a specific ICD-10 etiology (e.g., E11.51, I70.261, S72.xx) that clearly supports medical necessity for amputation
Global period conflict: postoperative E/M claims submitted without modifier 24 or 25 are auto-denied when 27591 is active in the global window
Incorrect site modifier — if bilateral amputations are performed in rare staged settings, absent LT/RT modifiers cause processing errors
Claim billed with 27590 and 27591 together for the same encounter without documentation of distinct services

Frequently asked questions

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

01What separates 27591 from 27590?

27591 requires immediate prosthetic fitting and application of the first cast at the time of surgery. 27590 is the same transfemoral amputation without that immediate fitting step. If the fitting was not performed intraoperatively, bill 27590 — don't use 27591 and hope it sticks.

02Can 27591 and 27592 be billed together?

No. 27591 (immediate fitting technique) and 27592 (open/guillotine technique) describe mutually exclusive approaches to transfemoral amputation. Bill whichever technique was actually performed.

03How does the 90-day global period affect postoperative prosthetic management billing?

Routine postoperative visits are bundled through day 90. Prosthetic fitting services billed by an orthotist or prosthetist under their own NPI are separate and not subject to the surgeon's global period. Surgeon visits for unrelated conditions need modifier 24.

04What modifier applies if the amputation is abandoned after anesthesia induction but before completion?

Use modifier 74 (discontinued outpatient procedure after anesthesia administration). Document the reason the procedure was stopped in the operative note.

05Is a staged revision or re-amputation during the global period billable?

A planned staged revision uses modifier 58. An unplanned return to the OR for a complication related to the original amputation uses modifier 78. An unrelated procedure uses modifier 79. Misapplying 78 vs. 79 is a common audit finding.

06Does the Stark Law code list affect how this code is billed in a physician-owned facility?

Yes. CPT 27591 appears on the CMS Stark Law CPT/HCPCS code list as a designated health service. Referrals to physician-owned entities for this procedure must meet a recognized Stark exception. Confirm compliance before billing from an owned ASC or 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 amputation level on the femur, confirms intraoperative immediate prosthetic fitting and first cast application, documents the closure technique (myodesis, myoplasty, skin flap design), and logs the qualifying diagnosis. That specificity prevents downcoding to 27590 — the most common audit flag for this code — and eliminates operative note deficiencies that trigger medical necessity denials.

See how Mira captures CPT 27591 documentation