Arthroscopic surgical procedure on the hip joint involving removal of inflamed synovial membrane tissue.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $757.20
- Total RVUs
- 22.67
- Global, days
- 90
- Region
- Hip
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 6 cited references ↓
- Confirmed diagnosis of synovitis or inflammatory synovial disease documented in pre-op and H&P notes
- Operative report naming specific portals used and extent of synovial tissue excised
- Pathology or specimen disposition noted if synovial tissue is sent for analysis
- Medical necessity narrative explaining why conservative management was exhausted or insufficient
- Laterality documented explicitly — left, right, or bilateral — matching the claim modifier
- If billed same-session as 29862 or other hip arthroscopy codes, distinct anatomic or procedural basis documented for each
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 6 cited references ↓
CPT 29863 covers hip arthroscopy performed specifically to excise hypertrophic or inflamed synovial tissue from within the hip joint. It is used for conditions driving synovitis — rheumatoid arthritis, pigmented villonodular synovitis (PVNS), chronic inflammatory arthropathy, and post-arthroplasty synovial irritation among them. The surgeon works through arthroscopic portals to visualize and resect the affected synovium, irrigate the joint, and confirm clearance before closure.
The code carries a 90-day global period. All routine post-op visits, wound checks, and related services within that window are included in the surgical payment — bill an unrelated E/M with modifier 24 if a distinct problem is addressed. When the operative session also includes labral debridement, chondroplasty (29862), or FAI correction (29914/29915/29916), NCCI bundling rules apply: 29863 is non-payable when billed alongside 29914, 29915, or 29916. Append modifier 59 only when a genuinely distinct service supports it — not as a routine bypass tool.
The procedure is performed in both hospital outpatient (HOPD) and ASC settings; site-of-service differences in facility payment are material. Diagnosis coding must support synovitis specifically — linking 29863 solely to articular cartilage pathology diagnoses (e.g., M24.151) without documenting synovial disease is a common trigger for denial.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 10.89 |
| Practice expense RVU | 9.66 |
| Malpractice RVU | 2.12 |
| Total RVU | 22.67 |
| Medicare national rate | $757.20 |
| 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 | $757.20 |
HOPD (APC 5113) Hospital outpatient department | $3,342.87 |
ASC (PI A2) Ambulatory surgical center (freestanding) | $1,644.87 |
Common denial reasons
The recurring reasons claims for CPT 29863 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Diagnosis code reflects articular cartilage pathology without documentation of synovial disease, creating a CPT-ICD mismatch
- Bundled denial when 29863 is submitted alongside 29914, 29915, or 29916 without NCCI override authority
- Medical necessity not established — no documentation of failed conservative treatment for synovitis
- Missing laterality modifier causing claim rejection or payer-specific edit failure
- Global period conflict when billed within 90 days of a prior hip surgical procedure without appropriate modifier
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01Can 29863 and 29862 be billed together for the same hip on the same day?
02Is 29863 billable alongside 29914, 29915, or 29916?
03What ICD-10 codes best support medical necessity for 29863?
04Does the 90-day global period affect billing for post-op visits after 29863?
05How does site of service affect reimbursement for 29863?
06Can 29863 be billed after a prior total hip arthroplasty on the same side?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02fastrvu.comhttps://fastrvu.com/cpt/29863
- 03events.hcpro.comhttps://events.hcpro.com/app/uploads/2024/02/0228232.pdf
- 04aapc.comhttps://www.aapc.com/codes/cpt-codes/29863
- 05cms.govhttps://www.cms.gov/medicare-medicaid-coordination/national-correct-coding-initiative-ncci/ncci-medicare/medicare-ncci-procedure-procedure-ptp-edits
- 06sciencedirect.comhttps://www.sciencedirect.com/science/article/pii/S2666061X2400124X
Mira AI Scribe
Mira's AI scribe captures the specific synovial compartments accessed, extent of synovectomy performed, portal placement, and the underlying inflammatory diagnosis driving the procedure. It flags when the operative dictation references only cartilage or labral findings without explicit synovitis language — the documentation gap most likely to produce a CPT-ICD mismatch denial on 29863.
See how Mira captures CPT 29863 documentation