{"id":159093,"date":"2026-07-20T10:08:14","date_gmt":"2026-07-20T10:08:14","guid":{"rendered":"https:\/\/pabau.com\/?p=159093"},"modified":"2026-08-13T12:04:19","modified_gmt":"2026-08-13T12:04:19","slug":"cpt-code-27130","status":"publish","type":"post","link":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-27130\/","title":{"rendered":"CPT Code 27130: Total hip arthroplasty billing guide"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"CPT Code 27130: Total hip arthroplasty billing guide\",\"description\":\"CPT code 27130 covers arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty). Covers Medicare reimbursement, modifiers, ICD-10 codes, and documentation.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/cpt-code-27130\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-07-20\",\"dateModified\":\"2026-07-20\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key Takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key Takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>CPT code 27130 describes arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty)<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Medicare reimburses CPT 27130 in both hospital outpatient and ASC settings. Verify current rates via the CMS Physician Fee Schedule each calendar year<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Always append laterality modifiers LT or RT. Missing a modifier is one of the most common denial triggers for this code<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Pabau&#8217;s claims management software flags incomplete modifier and ICD-10 pairings before submission, reducing first-pass denials for high-complexity surgical codes like 27130<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">CPT code 27130 is one of the highest-value codes in orthopedic billing, and payer scrutiny matches that value. Incomplete documentation, missing laterality modifiers, and ICD-10 codes that don&#8217;t match the payer&#8217;s current coverage criteria drive most claim denials for this procedure.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This guide covers the official code description, current Medicare reimbursement data, applicable modifiers, covered ICD-10-CM diagnosis codes, documentation requirements, and the related codes billing teams need to know.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Orthopedic practices billing CPT 27130 face a dual challenge: satisfying Medicare&#8217;s medical necessity criteria while simultaneously meeting commercial payer pre-authorization requirements. Both demand the same underlying documentation, but the specific covered diagnosis codes and utilization guidelines can differ by payer and by MAC jurisdiction.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Getting the claim right the first time starts with understanding exactly what this code covers and what each payer needs to see.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"CPT Coding Pitfalls Every Medical Practice Faces\" width=\"800\" height=\"450\" src=\"https:\/\/www.youtube.com\/embed\/vbvV5okdXKg?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 id=\"h-cpt-code-27130-definition-and-official-description\" class=\"wp-block-heading\">CPT Code 27130: Definition and official description<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT code 27130 is the standard billing code for total hip arthroplasty (THA), one of the most commonly performed major orthopedic procedures in the United States. According to the <a href=\"https:\/\/www.ama-assn.org\/practice-management\/cpt\/cpt-code-set-overview\" target=\"_blank\" rel=\"nofollow noopener\">American Medical Association&#8217;s CPT code set<\/a>, the official descriptor for this code is:<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Field<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Detail<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">CPT Code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">27130<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Official descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code type<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Category I CPT surgical code<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Surgical section<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Musculoskeletal system: Pelvis and Hip Joint<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Global period<\/td>\n<td style=\"padding:12px 16px;color:#374151\">090 days<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">ASC eligible<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes (added to the Medicare ASC Covered Procedures List effective January 1, 2021, via the CY2021 OPPS\/ASC Final Rule)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The procedure replaces both the acetabulum (socket) and the proximal femoral head (ball) with prosthetic components. It includes primary THA performed with or without bone grafting from the patient (autograft) or a donor source (allograft). A separate CPT code applies if only the femoral component is replaced (see CPT 27125 in the Related Codes section below).<\/p>\n\n\n\n<h2 id=\"h-rvu-breakdown-for-cpt-code-27130\" class=\"wp-block-heading\">RVU breakdown for CPT code 27130<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Relative Value Units (RVUs) determine Medicare reimbursement for CPT 27130 under the Medicare Physician Fee Schedule (MPFS). CMS updates these values annually. The figures below reflect the CY2026 Medicare Physician Fee Schedule. Verify the current year values using the <a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">CMS Physician Fee Schedule lookup tool<\/a>.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">RVU Component<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Facility<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Non-Facility<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Work RVU (wRVU)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">19.11<\/td>\n<td style=\"padding:12px 16px;color:#374151\">19.11<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Practice Expense RVU (PE)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">11.63<\/td>\n<td style=\"padding:12px 16px;color:#374151\">11.63<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Malpractice RVU (MP)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">4.05<\/td>\n<td style=\"padding:12px 16px;color:#374151\">4.05<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Total RVU<\/td>\n<td style=\"padding:12px 16px;color:#374151\">34.79<\/td>\n<td style=\"padding:12px 16px;color:#374151\">34.79<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">RVU values are multiplied by the annual CMS conversion factor to produce the Medicare allowable payment. Geographic practice cost indices (GPCIs) adjust the PE and MP components by location. Practices billing in high-cost metropolitan areas typically see higher allowables than rural settings for the same code.<\/p>\n\n\n\n<h2 id=\"h-indications-and-medical-necessity-for-total-hip-arthroplasty\" class=\"wp-block-heading\">Indications and medical necessity for total hip arthroplasty<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare and most commercial payers cover CPT 27130 when specific clinical criteria are met. Coverage criteria are defined in Local Coverage Determinations (LCDs) issued by each Medicare Administrative Contractor (MAC). Always check the applicable LCD for your jurisdiction before submitting. Common indications include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Severe hip osteoarthritis (M16.x):<\/strong> The most common indication. Documentation must show radiographic evidence of joint space narrowing plus functional impairment.<\/li>\n\n\n\n<li><strong>Rheumatoid arthritis affecting the hip (M05.x, M06.x):<\/strong> Typically requires evidence of failed disease-modifying therapy before surgical approval.<\/li>\n\n\n\n<li><strong>Avascular necrosis of the femoral head (M87.x):<\/strong> Stage III or IV AVN with collapse of the femoral head generally meets medical necessity criteria.<\/li>\n\n\n\n<li><strong>Hip fractures (S72.x):<\/strong> Displaced femoral neck fractures in appropriate surgical candidates may be treated with THA rather than hemiarthroplasty.<\/li>\n\n\n\n<li><strong>Inflammatory spondyloarthropathy involving the hip (M45.x):<\/strong> Ankylosing spondylitis is a less common but recognized indication when conservative management fails and imaging confirms joint destruction.<\/li>\n\n\n\n<li><strong>Failed conservative management:<\/strong> Most payers require documented failure of non-surgical treatment (physical therapy, NSAIDs, corticosteroid injections) for a defined period before approving elective THA.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Medical necessity criteria vary by MAC and commercial payer. Never assume universal coverage based on diagnosis alone. Verify the specific LCD applicable to your MAC jurisdiction and confirm commercial payer clinical policy bulletins (such as Aetna CPB 0287) before billing.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Document the failure of conservative treatment in the medical record with specific dates, treatment modalities attempted, and the patient&#8217;s functional limitation score before submitting a prior authorization request for CPT 27130. Payers routinely deny claims where conservative treatment failure is stated but not evidenced.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-medicare-reimbursement-rates-for-cpt-code-27130\" class=\"wp-block-heading\">Medicare reimbursement rates for CPT code 27130<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT 27130 is reimbursed in both hospital outpatient (HOPD) and ambulatory surgical center (ASC) settings under Medicare. CMS removed total hip arthroplasty from the Inpatient-Only (IPO) list in the CY2020 OPPS\/ASC Final Rule (CMS-1717-FC), then separately added it to the ASC Covered Procedures List effective January 1, 2021, via the CY2021 OPPS\/ASC Payment System Final Rule (CMS-1736-FC).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Rates below are approximate CY2026 national averages, unadjusted for geographic locality. Actual payments vary by MAC jurisdiction and are updated annually.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Setting<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Approximate Medicare Payment<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Payment System<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Hospital Outpatient (HOPD)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">~$13,100 (facility fee)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">OPPS (APC-based)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Ambulatory Surgical Center (ASC)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">~$9,600 (facility fee)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">ASC fee schedule<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Physician (facility rate)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">~$1,162 (professional fee)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">MPFS (facility)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Physician professional fees are billed separately from facility fees. The surgeon bills CPT 27130 against the MPFS facility rate regardless of whether the procedure is performed at a hospital or ASC.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The facility (hospital or ASC) bills the facility fee under OPPS or the ASC payment system, respectively. Implant costs are typically bundled into the facility payment and are not separately billable by the surgeon.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Facility payment figures reflect CY2026 OPPS Addendum B (HOPD, Comprehensive APC 5115) and ASC Addendum AA\/BB national rates. Confirm current amounts against the applicable CMS addendum before estimating reimbursement, since these update annually and vary by geographic wage index.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For orthopedic practices tracking revenue cycle performance. This is especially valuable for high-value surgical codes like 27130, where a single denial can hold up thousands of dollars in reimbursement.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-27130\/automate-claims-through-healthcode.webp\" alt=\"Automate claims and billing with Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Automate claims and billing with Pabau<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 id=\"h-applicable-modifiers-for-cpt-code-27130\" class=\"wp-block-heading\">Applicable modifiers for CPT code 27130<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Modifier selection is one of the most denial-sensitive aspects of billing CPT 27130. Laterality modifiers are required for every claim. Applying the wrong modifier, or omitting it entirely, will result in an automatic denial from most payers.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to apply<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">LT<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Left side<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Total hip arthroplasty performed on the left hip<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">RT<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Right side<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Total hip arthroplasty performed on the right hip<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">50<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Bilateral procedure<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Bilateral THA in the same operative session; verify payer-specific rules before applying<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">22<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Increased procedural services<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Procedure substantially more complex than usual; requires detailed operative note justification<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">52<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Reduced services<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Procedure partially reduced at surgeon&#8217;s discretion; reduces reimbursement proportionally<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">62<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Two surgeons<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Two surgeons perform distinct portions of the procedure; each bills 27130-62<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">For left-side procedures, use the left total hip arthroplasty CPT code pairing: 27130-LT. For right-side procedures, use 27130-RT. Bilateral modifier 50 rules vary significantly by payer.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare generally processes bilateral procedures billed with modifier 50 at 150% of the single-procedure rate. The first side pays 100% and the second pays 50%. Confirm this with the applicable MAC before billing.<\/p>\n\n\n\n<h2 id=\"h-icd-10-diagnosis-codes-that-support-cpt-27130\" class=\"wp-block-heading\">ICD-10 diagnosis codes that support CPT 27130<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Pairing CPT 27130 with a supported ICD-10-CM diagnosis code is essential for establishing medical necessity. The table below lists the most commonly used covered diagnosis codes, based on CMS Article A57683.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The full covered code list is maintained in MAC-specific LCDs. Always consult the current published version for your jurisdiction. Use the <a href=\"https:\/\/www.aapc.com\/codes\/cpt-codes-range\/\" target=\"_blank\" rel=\"nofollow noopener\">AAPC Codify CPT lookup<\/a> or a crosswalk tool to verify ICD-10 pairings before submission.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">ICD-10-CM Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Clinical Context<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">M16.11<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Primary osteoarthritis, right hip<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Most common indication; use with modifier RT<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">M16.12<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Primary osteoarthritis, left hip<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Most common indication; use with modifier LT<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">M87.051<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Avascular necrosis of bone, right femur<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Stage III\/IV AVN with femoral head collapse<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">M87.052<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Avascular necrosis of bone, left femur<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Stage III\/IV AVN with femoral head collapse<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">M05.651<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Rheumatoid arthritis with involvement of right hip<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Requires evidence of failed DMARD therapy<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">M05.652<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Rheumatoid arthritis with involvement of left hip<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Requires evidence of failed DMARD therapy<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S72.001A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Displaced femoral neck fracture, right femur, initial encounter<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Acute fracture indication; patient selection criteria apply<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">M16.2<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Bilateral primary osteoarthritis of hip<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use when billing bilateral THA with modifier 50<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Hip arthroplasty ICD-10 code selection must be laterality-specific wherever the code set offers side-specific options. Using an unspecified code (e.g., M16.10) when a laterality-specific code exists may trigger an edit or denial, particularly under MAC-issued LCD policies.<\/p>\n\n\n\n<h2 id=\"h-documentation-requirements-for-billing-cpt-27130\" class=\"wp-block-heading\">Documentation requirements for billing CPT 27130<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Incomplete documentation is the second most common denial reason for CPT 27130, after modifier errors. CMS Article A57683 and most MAC LCDs specify the minimum documentation elements required to support a claim. Practice administrators managing medical forms should pre-configure surgical note templates to capture all required fields before the operative date.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Pre-operative imaging:<\/strong> AP and lateral hip radiographs with documented findings (joint space narrowing, osteophyte formation, subchondral sclerosis, or femoral head changes)<\/li>\n\n\n\n<li><strong>Conservative treatment failure documentation:<\/strong> Specific dates, duration, and outcomes of non-surgical treatment including physical therapy, NSAIDs, intra-articular injections<\/li>\n\n\n\n<li><strong>Functional impairment documentation:<\/strong> Validated patient-reported outcome scores (e.g., HOOS, Harris Hip Score) or documented limitation of activities of daily living<\/li>\n\n\n\n<li><strong>Operative note:<\/strong> Complete description of surgical approach, components implanted (manufacturer, size, lot number), and intraoperative findings<\/li>\n\n\n\n<li><strong>Anesthesia documentation:<\/strong> Type of anesthesia and ASA physical status classification<\/li>\n\n\n\n<li><strong>Medical necessity letter:<\/strong> Narrative supporting the clinical decision for surgery, referencing failed conservative management and imaging findings<\/li>\n\n\n\n<li><strong>Pre-authorization documentation:<\/strong> Payer authorization number, date issued, and authorized CPT codes. Maintain with the claim file<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Pre-authorization is required by most major commercial payers for CPT 27130. Requirements vary by payer and plan. Confirm authorization requirements directly with each commercial payer before scheduling the procedure. Medicare does not require prior authorization for CPT 27130, but documentation must still meet LCD medical necessity criteria for the claim to pay.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Build a CPT 27130 documentation checklist into your pre-surgical workflow. Review imaging dates, conservative treatment records, and functional outcome scores at least two weeks before the scheduled procedure. Identifying missing documentation at this stage, rather than post-operatively, prevents last-minute claim delays and reduces the risk of retrospective denials during audit.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-related-cpt-codes-for-hip-arthroplasty\" class=\"wp-block-heading\">Related CPT codes for hip arthroplasty<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Selecting the correct CPT code for hip arthroplasty depends on the type of procedure performed:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Primary total replacement<\/li>\n\n\n\n<li>Partial replacement<\/li>\n\n\n\n<li>Conversion<\/li>\n\n\n\n<li>Revision<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Billing 27130 for a procedure that should be coded as a revision or partial replacement will result in a denial. The table below covers the core hip arthroplasty code family, including CPT 27447 for cross-reference to the analogous total knee arthroplasty procedure.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CPT Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Key Distinction<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">27130<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Total hip arthroplasty (acetabular and femoral components)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Primary procedure; both components replaced<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">27125<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Hemiarthroplasty, hip (partial hip replacement)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Femoral component only; acetabulum preserved<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">27132<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Conversion of previous hip surgery to total hip arthroplasty<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use when converting from hemiarthroplasty, failed ORIF, or other prior hip surgery to THA<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">27134<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Revision of total hip arthroplasty, both components<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Both components revised; highest RVU revision code<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">27137<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Revision of total hip arthroplasty, acetabular component only<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Acetabular component only revised; femoral component retained<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">27138<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Revision of total hip arthroplasty, femoral component only<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Femoral component only revised; acetabular component retained<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">27447<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Total knee arthroplasty (analogous knee code)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Cross-reference for knee replacement billing; same billing principles, different joint<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">For practices billing both hip and knee arthroplasty, <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-27447\/\">27447<\/a> follows similar documentation and modifier principles to 27130. Orthopedic billing teams should be familiar with all codes in the 27125-27138 range to avoid miscoding between primary, conversion, and revision procedures.<\/p>\n\n\n\n<h2 id=\"h-common-billing-errors-and-denial-prevention-for-cpt-27130\" class=\"wp-block-heading\">Common billing errors and denial prevention for CPT 27130<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Total hip arthroplasty billing is high-dollar and high-scrutiny. Payers apply multiple claim edits to this code specifically because of its reimbursement value. The most preventable denials fall into four categories.<\/p>\n\n\n\n<h3 id=\"h-missing-or-incorrect-laterality-modifier\" class=\"wp-block-heading\">Missing or incorrect laterality modifier<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Submitting 27130 without LT or RT is the single most common denial trigger. Most clearinghouses will reject the claim before it reaches the payer. Build modifier LT\/RT as a required field in your practice management system for this code. A claim for left total hip arthroplasty CPT code billing must always include the LT modifier.<\/p>\n\n\n\n<h3 id=\"h-unsupported-icd-10-pairing\" class=\"wp-block-heading\">Unsupported ICD-10 pairing<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Billing CPT 27130 with a diagnosis code not on the payer&#8217;s covered list will trigger a medical necessity denial. This is most common when coders use unspecified osteoarthritis codes (M16.10) instead of laterality-specific codes, or when the diagnosis code doesn&#8217;t match the operative side.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Following the same HIPAA compliance documentation standards used elsewhere in the practice helps ensure the operative record, diagnosis, and claim all align.<\/p>\n\n\n\n<h3 id=\"h-miscoding-revision-as-primary\" class=\"wp-block-heading\">Miscoding revision as primary<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Billing 27130 for a procedure that involved revision of a previously placed implant will result in a claim edit or denial. Review operative notes carefully.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If the surgeon documents removal and replacement of an existing prosthetic component, the revision codes (27134, 27137, or 27138) apply, not 27130. A revision prompted by hardware failure is often coded with a bone continuity disorder such as M84.9 as a secondary diagnosis, alongside the revision procedure code.<\/p>\n\n\n\n<h3 id=\"h-incomplete-pre-authorization-or-expired-authorization\" class=\"wp-block-heading\">Incomplete pre-authorization or expired authorization<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Commercial payer authorizations for CPT 27130 are typically valid for a defined window (often 90-180 days). Performing the surgery after the authorization expiration date results in a denial even when all clinical criteria are met. Tracking authorization expiration dates is a critical administrative function for orthopedic practices.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-27130\/automated-communication-in-pabau.webp\" alt=\"Automated communication in Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Automated communication in Pabau<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 id=\"h-how-practice-management-software-supports-cpt-27130-billing-workflows\" class=\"wp-block-heading\">How practice management software supports CPT 27130 billing workflows<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Standalone coding reference sites can tell you what a code means. They cannot prevent the errors that generate denials. Submitting a clean claim for CPT 27130 requires:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Documentation capture<\/li>\n\n\n\n<li>Modifier validation<\/li>\n\n\n\n<li>ICD-10 pairing checks<\/li>\n\n\n\n<li>Authorization tracking<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Pabau&#8217;s claims management software connects these steps, flagging issues before a claim reaches the clearinghouse rather than after it returns as a denial.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For orthopedic and <a href=\"https:\/\/pabau.com\/industry\/sports-medicine-software\/\">sports medicine practices<\/a>, the specific value is in pre-submission scrubbing. When a claim for CPT 27130 is assembled, the system can check that a laterality modifier is present, that the linked ICD-10 code is on the payer&#8217;s covered list, and that required documentation fields are populated.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-27130\/customizable-consent-and-intake-forms.webp\" alt=\"Customizable consent and intake forms\"\/><figcaption class=\"wp-element-caption\"><em>Customizable consent and intake forms<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Practices managing both Medicare and commercial payer billing can also use practice management software to track per-payer authorization requirements and expiration dates, reducing the risk of billing outside an authorized window.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For multi-provider orthopedic groups.<\/p>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Related CPT codes<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-22840\/\">CPT code 22840 \u2014 Posterior Non-Segmental Instrumentation<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-27299\/\">CPT code 27299 \u2014 Unlisted Procedure, Pelvis or Hip Joint<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-27570\/\">CPT code 27570 \u2014 Knee Manipulation Under Anesthesia<\/a><\/li>\n<\/ul>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Reduce claim denials for high-value surgical codes                <\/h3>\n\n                <p class=\"description\">\n                    Pabau&#8217;s claims management tools flag missing modifiers, unsupported ICD-10 pairings, and missing documentation before your CPT 27130 claims reach the payer. See how it works in your workflow.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau claims management dashboard for orthopedic billing\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">For practices billing total hip arthroplasty regularly, these requirements are manageable only when the documentation and billing workflow are integrated.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pabau&#8217;s claims management software brings together clinical documentation, coding validation, and claim scrubbing in a single platform, so the checks happen before submission, not after a denial. To see how it handles complex surgical codes like CPT 27130, <a href=\"https:\/\/pabau.com\/book-demo\/\">book a demo<\/a> and walk through the workflow with your billing context in mind.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Coding a related musculoskeletal diagnosis?<\/strong> ICD-10 code <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-m929\/\">M92.9<\/a> covers documentation and billing considerations for juvenile osteochondrosis.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Billing for spine-adjacent conditions?<\/strong> ICD-10 code <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-m539\/\">M53.9<\/a> explains how unspecified dorsopathy is coded and supported for claims.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Need guidance on inflammatory bone conditions?<\/strong> ICD-10 code <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-m881\/\">M88.1<\/a> covers documentation requirements for osteitis deformans of the vertebrae.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Looking for broader connective tissue diagnosis coding?<\/strong> ICD-10 code <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-m368\/\">M36.8<\/a> covers classification and billing for systemic connective tissue disorders.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-frequently-asked-questions\" class=\"wp-block-heading\">Frequently Asked Questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1784537618560\"><h3 class=\"schema-faq-question\">What does CPT code 27130 cover?<\/h3> <p class=\"schema-faq-answer\">CPT code 27130 is arthroplasty, acetabular and proximal femoral prosthetic replacement, the billing descriptor for primary total hip arthroplasty (THA) in which both the acetabular socket and femoral head components are replaced with prosthetic implants. It covers procedures performed with or without autograft or allograft bone grafting. Partial replacement of the femoral component only is reported separately under CPT 27125.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784537618561\"><h3 class=\"schema-faq-question\">What is the Medicare reimbursement rate for CPT 27130?<\/h3> <p class=\"schema-faq-answer\">The Medicare physician professional fee for CPT 27130 is approximately $1,162 at the facility rate under the CY2026 Medicare Physician Fee Schedule. Facility fees are billed separately: approximately $13,100 for hospital outpatient (HOPD) and $9,600 for ambulatory surgical centers (ASC), per CY2026 OPPS\/ASC national averages. Exact rates vary by geographic locality and are updated annually, so verify current rates using the CMS Physician Fee Schedule lookup tool before billing.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784537618562\"><h3 class=\"schema-faq-question\">What modifiers are used with CPT code 27130?<\/h3> <p class=\"schema-faq-answer\">Laterality modifiers LT (left) or RT (right) are required on every CPT 27130 claim. Modifier 50 applies for bilateral total hip arthroplasty performed in the same operative session, but payer-specific rules govern how bilateral procedures are processed and paid. Modifier 22 is appropriate when the procedure is substantially more complex than usual, and modifier 62 applies when two surgeons each perform a distinct portion of the procedure.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784537618563\"><h3 class=\"schema-faq-question\">What ICD-10 codes support medical necessity for CPT 27130?<\/h3> <p class=\"schema-faq-answer\">The most commonly used ICD-10-CM codes supporting medical necessity for CPT 27130 include M16.11 and M16.12 (primary osteoarthritis, right and left hip), M87.051 and M87.052 (avascular necrosis of the femur), M05.651 and M05.652 (rheumatoid arthritis of the hip), and S72.001A (displaced femoral neck fracture, initial encounter). Always verify the covered diagnosis code list in the applicable MAC LCD, as covered codes can change with each fiscal year update.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784537618564\"><h3 class=\"schema-faq-question\">How is CPT 27130 different from CPT 27447?<\/h3> <p class=\"schema-faq-answer\">CPT 27130 is total hip arthroplasty (hip joint), while CPT 27447 is total knee arthroplasty (knee joint). They are anatomically distinct procedures with separate RVU values, fee schedules, and ICD-10 pairing requirements. Both codes follow similar billing principles, including laterality modifiers and conservative treatment failure documentation requirements, but they cannot be substituted for each other.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784537618565\"><h3 class=\"schema-faq-question\">Is CPT 27130 performed in an ASC setting?<\/h3> <p class=\"schema-faq-answer\">Yes. CMS removed total hip arthroplasty from the Medicare Inpatient-Only list in the CY2020 OPPS\/ASC Final Rule, then added it to the Medicare ASC Covered Procedures List effective January 1, 2021, via the CY2021 OPPS\/ASC Payment System Final Rule. ASC facility payments for CPT 27130 are governed by the ASC payment system and are typically lower than hospital outpatient facility fees. Patient selection criteria for ASC-based THA apply, and commercial payer ASC coverage may differ from Medicare.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784537618566\"><h3 class=\"schema-faq-question\">What is the left total hip arthroplasty CPT code?<\/h3> <p class=\"schema-faq-answer\">There is no separate CPT code for left versus right total hip arthroplasty. The single code CPT 27130 is used for both sides, with laterality indicated by appending modifier LT for the left hip or RT for the right hip. Always include the laterality modifier. Submitting CPT 27130 without LT or RT is a common cause of automatic claim denials.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>CPT code 27130 is one of the highest-value codes in orthopedic billing, and payer scrutiny matches that value. Incomplete documentation, missing laterality modifiers, and ICD-10 codes that don&#8217;t match the payer&#8217;s current coverage criteria drive most claim denials for this procedure. This guide covers the official code description, current Medicare reimbursement data, applicable modifiers, covered [&hellip;]<\/p>\n","protected":false},"author":77,"featured_media":159092,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"89","_yoast_wpseo_content_score":"30","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1546],"tags":[4260,1162,1163,1666,4261],"class_list":["post-159093","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-cpt-codes","tag-cpt-27130","tag-cpt-codes","tag-medical-billing","tag-orthopedic-billing","tag-total-hip-arthroplasty"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.2 (Yoast SEO v28.2) - 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Outside of work, she's usually chasing her border collie around muddy fields or hunting down the best flat white in town.","url":"https:\/\/pabau.com\/es\/blog\/author\/katy-piper\/"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-27130\/#faq-question-1784537618560","position":1,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-27130\/#faq-question-1784537618560","name":"What does CPT code 27130 cover?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT code 27130 is arthroplasty, acetabular and proximal femoral prosthetic replacement, the billing descriptor for primary total hip arthroplasty (THA) in which both the acetabular socket and femoral head components are replaced with prosthetic implants. It covers procedures performed with or without autograft or allograft bone grafting. 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