Arthroscopy · Hip

Arthroscopic hip surgery involving the visualization and extraction of loose or foreign bodies from within the hip joint.

Verified May 8, 2026 · 5 sources ↓

Medicare: $657.33
Total RVUs: 19.68
Global, days: 90
Region: Hip

Drawn from CMSAAPC

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Operative note must specify the size of the loose or foreign body relative to the arthroscopic cannula diameter — the body must be at least as large as the cannula.
Document whether removal required a separate incision or an enlarged portal, per December 2020 AMA revised guidelines.
Identify the nature of the loose body (e.g., cartilage fragment, bone chip, displaced suture anchor, hardware debris) and its presumed origin.
Record the number, location, and size of portals used, and describe the joint compartments inspected.
If concurrent procedures were performed, document each distinctly in the operative note with clinical justification for separate reporting.
Include ICD-10 diagnosis code(s) that establish medical necessity — M24.051–M24.052 (loose body in hip) are typical primary diagnoses.

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 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

29861 covers arthroscopic removal of loose or foreign bodies from the hip joint — including cartilage fragments, bone chips, and hardware debris such as broken suture anchors from prior procedures. These fragments cause pain, synovitis, adhesions, and progressive loss of motion when left in place. The procedure requires arthroscopic visualization of the joint space and physical extraction of material meeting the December 2020 AMA size threshold: the loose body must be equal to or larger than the diameter of the arthroscopic cannula and require either a separate incision or an enlarged portal for removal. This revision was significant — bodies smaller than cannula diameter removed through the standard portal no longer qualify for 29861 and should not be reported separately.

The 90-day global period covers all routine post-op care through day 90, including office visits, dressing changes, and suture removal. Any visit for an unrelated condition during the global window requires modifier 24. A staged or planned return to the OR for a related procedure requires modifier 78; an unrelated return-to-OR procedure takes modifier 79. Sports medicine dominates the PUF billing profile for this code, though orthopedic surgeons bill it routinely as well.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.85
Practice expense RVU	8.01
Malpractice RVU	1.82
Total RVU	19.68
Medicare national rate	$657.33
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	$657.33
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 29861 get rejected.

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

Loose body smaller than cannula diameter: post-2020 guidelines require the body to equal or exceed cannula size — smaller fragments bundled into the basic arthroscopy are not separately billable.
Removal performed through the standard portal without enlargement, failing the separate-incision-or-enlarged-portal criterion introduced in the December 2020 AMA revision.
Operative note lacks size documentation or uses vague language like 'loose debris removed,' giving reviewers no basis to confirm the 2020 threshold was met.
Procedure billed with a diagnosis that doesn't support loose body pathology — mismatched ICD-10 triggers medical necessity denial.
Global period conflict: follow-up visit billed without modifier 24 or 25 within the 90-day global window, causing automatic denial.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What changed with 29861 after December 2020?

The AMA revised the reporting criteria to require that the loose body be at least as large as the arthroscopic cannula diameter AND that removal required either a separate incision or an enlarged portal. Fragments removed through a standard portal without enlargement no longer qualify for separate billing under 29861.

02Can I bill 29861 with other hip arthroscopy codes on the same day?

Yes, but each additional procedure needs independent documentation of distinct work. Append modifier 51 to the lower-RVU procedure and verify NCCI edits — some hip arthroscopy code pairs have column-one/column-two relationships that require modifier 59 or XS to override.

03What ICD-10 codes typically support 29861?

M24.051 and M24.052 (loose body in right and left hip, respectively) are the primary diagnosis codes. Foreign body-specific diagnoses or post-surgical hardware displacement codes may apply when the removed material is implant debris from a prior procedure.

04Does the 90-day global apply to both HOPD and ASC settings?

The 90-day global period is a physician-fee-schedule concept and applies to the operating surgeon's professional fee regardless of site of service. Facility payments (HOPD and ASC) are not subject to global period rules.

05If a suture anchor from a prior hip labral repair is the foreign body, does that support 29861?

Yes — displaced or broken hardware from prior surgery is a recognized indication. Document the implant type, its source procedure, its current position, and confirm it meets the size threshold relative to cannula diameter. Include an ICD-10 code for the complication of the prior procedure.

06Can I bill an E/M on the same day as 29861 if the decision for surgery was made that visit?

Yes. Append modifier 57 to the E/M when the visit on the day of or the day before surgery results in the decision to perform a major procedure (90-day global). That modifier distinguishes the decision-making visit from routine pre-op evaluation and prevents global-period denial.

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 loose body size relative to cannula diameter, the portal strategy (standard vs. enlarged or separate incision), and the nature of the extracted material directly from surgeon dictation. This prevents the most common audit flag for 29861: an operative note that documents removal but omits the specific size and portal details required by the December 2020 AMA coding revision — the gap that turns a clean claim into a medical necessity denial.

See how Mira captures CPT 29861 documentation