Arthroscopy · Hip

Arthroscopic surgical procedure on the hip joint that includes repair of the acetabular labrum.

Verified May 8, 2026 · 7 sources ↓

Medicare: $930.55
Total RVUs: 27.86
Global, days: 90
Region: Hip

Drawn from CMSMedicare.govAAPCPbn

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 name the specific labral pathology (tear location, size, pattern) and confirm arthroscopic visualization before repair
Document the repair technique explicitly — e.g., anchor-based reattachment, suture configuration — not just 'labral repair performed'
Pre-op imaging (MRI or MR arthrogram) confirming labral tear should be in the record to support medical necessity
If 29914 is billed concurrently, the note must separately describe the cam lesion, its resection, and the femoroplasty performed
Laterality must be specified in the operative note and on the claim (LT or RT modifier); bilateral is rare but requires modifier 50 with supporting documentation
If modifier 22 is appended for increased complexity, a separate written justification must accompany the claim explaining what made the work substantially greater than typical

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 62 Co-surgeons 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 7 cited references ↓

CPT 29916 covers hip arthroscopy with labral repair — the arthroscopic reattachment or reconstruction of the fibrocartilaginous labrum lining the acetabular rim. It carries a 90-day global period, meaning all routine post-op visits through day 90 are included in the payment. This is the highest-complexity standard hip arthroscopy code in the 29860–29916 range and is billed by orthopedic surgeons as the primary procedure when labral repair is the defining work performed.

Bundling rules here are strict and frequently misapplied. Per CPT guidelines confirmed in CPT Assistant (September 2011) and reinforced by NCCI edits, 29862 (debridement/chondroplasty/labral resection) is inclusive to 29916 — do not report them together. When a cam lesion is also addressed, bill 29914 (femoroplasty) separately with modifier 51 appended to the secondary code. The 29915/29916 pair is listed as mutually exclusive in NCCI edits, though a modifier can override the CMS edit — but AMA CPT guidelines say not to report them together at all. Follow AMA guidance to avoid audit exposure with commercial payers.

Site of service matters significantly for this code. The HOPD and ASC payment rates differ substantially; see the site-of-service comparison table on this page. If the procedure is converted from arthroscopic to open intraoperatively, report only the open code — neither the surgical arthroscopy nor a diagnostic arthroscopy code should be added to the open procedure claim.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	14.63
Practice expense RVU	10.33
Malpractice RVU	2.9
Total RVU	27.86
Medicare national rate	$930.55
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	$930.55
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI G2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 29916 get rejected.

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

29862 billed alongside 29916 — NCCI bundles debridement/chondroplasty into the labral repair; no modifier will override this edit per AMA guidelines
Missing or vague laterality — claims submitted without LT or RT are rejected by many payers as incomplete
Medical necessity not established — no pre-op MRI or clinical documentation of failed conservative treatment in the record
29915 billed with 29916 without understanding the AMA/CMS conflict — safe practice is to not report them together regardless of whether an NCCI modifier override is technically available
Post-op services billed within the 90-day global without modifier 24 or 79 — routine follow-up visits are bundled and will deny

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Can I bill 29862 with 29916 when the surgeon also debrided chondromalacia during the same hip scope?

No. CPT Assistant (September 2011) and NCCI edits both make 29862 inclusive to 29916. Articular cartilage debridement performed in the same hip at the same encounter is bundled into the labral repair code. Billing 29862 separately will deny, and no modifier overrides this for the hip.

02How do I bill when the surgeon repairs the labrum and also treats a cam lesion in the same hip?

Bill 29916 as the primary code (LT or RT) and 29914 as the secondary code with modifiers 51 and LT (or RT). Per the AAPC Orthopedic Coding Alert real-world scenario, this is the correct combination. Do not add 29862 — it remains bundled.

03Can 29915 (acetabuloplasty) and 29916 (labral repair) be billed together?

CMS NCCI lists them as mutually exclusive but allows a modifier to override the edit. AMA CPT guidelines say do not report them together. For Medicare, the safest position is to follow AMA guidance and avoid billing both. For commercial payers, confirm individual policy — some follow NCCI edit logic, others follow AMA.

04What modifier applies when the surgeon performs labral repair on a patient who had a prior hip scope within the 90-day global of a previous procedure?

Use modifier 79 if the labral repair is unrelated to the prior procedure, or modifier 78 if it's a return to the OR for a complication related to the prior surgery. Do not invert these — 78 is for related unplanned returns, 79 is for unrelated procedures during an active global period.

05Is labral reconstruction (graft-based) reported with 29916?

No. Labral reconstruction using allograft or autograft tissue is not described by 29916, which covers repair of the native labrum. Reconstruction is reported with an unlisted arthroscopy code (29999), compared to 29916 for valuation purposes. Document the graft source, fixation method, and why reconstruction was chosen over repair.

06Does converting a hip arthroscopy to an open procedure change what I bill?

Yes. Per NCCI Chapter 4 policy, if an arthroscopic procedure is converted to open, you report only the open procedure code. Do not add 29916 or a diagnostic arthroscopy code to the claim. The operative note must document the reason for conversion.

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 labral tear location (anterior, posterior, superior), repair technique (anchor count, suture configuration), cam or pincer pathology addressed, and all compartments accessed during the procedure. This prevents the most common audit flag for 29916 — an operative note that confirms repair was done but omits the structural detail needed to distinguish labral repair from labral debridement, which changes the code entirely.

See how Mira captures CPT 29916 documentation