Arthroscopy · Hip

Diagnostic arthroscopy of the hip joint, with or without synovial tissue biopsy, performed as a separate procedure.

Verified May 8, 2026 · 6 sources ↓

Medicare: $615.24
Total RVUs: 18.42
Global, days: 90
Region: Hip

Drawn from CMSAAPCWellpointFindacode

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Indication for diagnostic scope: specific symptom(s), duration, and prior conservative treatment tried and failed
Portal placement and patient positioning documented in the operative note — 'standard approach' language flags audits
Systematic description of all structures visualized: labrum, articular cartilage, synovium, ligamentum teres, and any identified pathology
If synovial biopsy obtained, document site sampled, number of specimens, and submission to pathology
Explicit documentation that no concurrent surgical procedure was performed, supporting the 'separate procedure' status
Pre-operative imaging (MRI or MR arthrogram) referenced to correlate intraoperative findings with clinical decision-making

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 59 Distinct service LT Left side RT Right side 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

29860 covers arthroscopic inspection of the hip joint to identify the source of pain, mechanical symptoms, or limited motion. The surgeon introduces a small-diameter scope through a portal, visualizes the labrum, articular cartilage, synovium, and other intra-articular structures, and may collect a synovial biopsy specimen for pathologic analysis. The phrase 'separate procedure' in the descriptor is critical: if the diagnostic scope leads directly to a surgical arthroscopy at the same encounter, 29860 is bundled into the surgical code and cannot be reported separately — only the surgical code is billable per NCCI policy.

29860 serves as the base code for the hip arthroscopy family. When additional surgical work is performed — loose body removal (29861), chondroplasty or labral resection (29862), synovectomy (29863), femoroplasty (29914), acetabuloplasty (29915), or labral repair (29916) — those surgical codes replace 29860, not supplement it. Under the Wellpoint/Anthem commercial multiple-procedure reimbursement policy, 29860 functions as the anchor at 100% with subsequent hip arthroscopy codes reduced to 25%.

The 90-day global period means all routine post-op hip arthroscopy visits through day 90 are included in the 29860 payment. An unrelated E/M in that window requires modifier 24. A separately identifiable E/M on the day of surgery requires modifier 25 on the E/M, not on 29860.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	8.78
Practice expense RVU	7.95
Malpractice RVU	1.69
Total RVU	18.42
Medicare national rate	$615.24
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	$615.24
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 29860 get rejected.

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

Bundling denial when 29860 is billed same-session with a surgical hip arthroscopy code — NCCI requires only the surgical code
Medical necessity denial when ICD-10 diagnosis does not support diagnostic arthroscopy over non-invasive imaging alternatives
Laterality mismatch — missing or incorrect LT/RT modifier causes claim rejection at many payers
Global period denial when a post-op visit is billed within the 90-day window without modifier 24 on an unrelated E/M
Unlisted or non-covered diagnosis pairing — payers expect pathology codes consistent with labral, cartilage, or synovial disease

Frequently asked questions

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

01Can I bill 29860 and 29916 together if the surgeon scoped diagnostically and then repaired the labrum?

No. Per NCCI Chapter 4, surgical arthroscopy includes diagnostic arthroscopy. If the diagnostic scope leads to a surgical procedure at the same encounter, report only the surgical code — 29916 in this case. Billing 29860 alongside it will trigger a bundling denial.

02When is 29860 separately billable alongside an open hip procedure?

If a diagnostic arthroscopy is performed first and the findings then drive the decision to convert to an open procedure, 29860 may be separately reported with modifier 58 to indicate it was a staged or planned pre-procedure step leading to the open surgery. Document the decision point explicitly in the operative note.

03Does 29860 require a left/right modifier?

Yes. Most payers, including Medicare, require LT or RT for unilateral joint procedures. Missing laterality is a common clean-claim failure. Use modifier 50 only if both hips are scoped in the same session.

04What is the multiple-procedure reduction rule for 29860 when billed with other hip arthroscopy codes?

Under commercial payer policies such as Wellpoint/Anthem, 29860 is the base code at 100% reimbursement, with subsequent hip arthroscopy codes in the 29861–29863 and 29914–29916 range reduced to 25%. Confirm each payer's specific policy, as Medicare applies its own multiple-surgery reduction rules.

05What ICD-10 diagnoses pair appropriately with 29860?

Diagnoses reflecting unresolved hip joint pathology are standard — labral tear, femoroacetabular impingement, synovitis, loose body, or unspecified hip pain with failed conservative management. Payers expect the diagnosis to justify arthroscopy over MRI alone; document prior imaging and failed non-operative treatment in the record.

06Is a synovial biopsy separately billable when performed during 29860?

No. The code descriptor includes 'with or without synovial biopsy,' meaning the biopsy is bundled into 29860. You cannot unbundle it to a separate biopsy CPT code at the same encounter.

07How does the 90-day global period affect post-op billing for 29860?

All routine follow-up visits related to the hip arthroscopy are included in the 29860 payment through day 90. Bill a new or unrelated condition seen in that window with modifier 24 on the E/M. A separately identifiable E/M on the day of surgery requires modifier 25 appended to the E/M code.

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 specific hip structures visualized (labrum, articular cartilage, synovium, ligamentum teres), whether a synovial biopsy was taken and submitted, portal placement, and the surgeon's finding-based rationale for stopping at diagnostic rather than proceeding to surgical arthroscopy. That structured note directly prevents the two most common 29860 audit flags: an operative report that omits a systematic structure-by-structure inspection narrative, and missing documentation of why a concurrent surgical code was or was not reported.

See how Mira captures CPT 29860 documentation