Summary & Overview
CPT 27130: Total Hip Arthroplasty (Acetabular and Femoral Prosthetic Replacement)
CPT code 27130 is a critical billing code for total hip arthroplasty, a procedure that replaces both the acetabular and proximal femoral components of the hip joint with prosthetic implants. This surgery is widely performed across the United States to address severe hip joint conditions, such as osteoarthritis and post-traumatic arthritis, and is a cornerstone of orthopedic care for patients seeking improved mobility and pain relief. The procedure is most commonly conducted in inpatient hospital settings by orthopedic surgeons.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, reflecting broad national coverage and relevance for providers and health systems. Readers will gain insights into clinical indications, typical sites of service, and payer coverage for this procedure. The publication also provides context on related CPT codes, common modifiers, and associated ICD-10 diagnoses, offering a comprehensive overview of the billing and policy landscape for total hip arthroplasty.
This summary serves as a resource for understanding national benchmarks, policy updates, and clinical context surrounding CPT code 27130, supporting informed decision-making for stakeholders across the healthcare continuum.
CPT Code Overview
CPT code 27130 represents total hip arthroplasty, a surgical procedure involving the replacement of both the acetabular and proximal femoral components of the hip joint with prosthetic implants. This procedure is performed by orthopedic surgeons and is typically indicated for patients with severe hip joint damage, such as osteoarthritis or post-traumatic arthritis, that significantly impairs mobility and quality of life. The service type is orthopedic surgery, and the most common site of service is the inpatient hospital setting (Place of Service 21). Total hip arthroplasty is a major intervention aimed at restoring function and alleviating pain in affected patients.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult patient admitted to an inpatient hospital setting with significant hip pain and functional limitation due to osteoarthritis or post-traumatic osteoarthritis. The patient has failed conservative management and is now scheduled for a total hip arthroplasty, which includes replacement of both the acetabular and proximal femoral components. The procedure is performed by an orthopedic surgeon, and may involve the use of autograft or allograft material. The clinical workflow includes preoperative assessment, surgical intervention, and postoperative care, often with physical therapy and monitoring for complications.
Coding Specifications
| Modifier Code | Description | When Used |
|---|---|---|
LT | Left side | Procedure performed on the left hip |
RT | Right side | Procedure performed on the right hip |
22 | Increased Procedural Services | Used when the procedure is significantly more complex or requires additional work |
78 | Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period | Used when the patient returns to the OR during the postoperative period for a related procedure by the same physician |
Associated Provider Taxonomies:
207XS0117X- Orthopaedic Surgery of the Spine207X00000X- Orthopaedic Surgery207XX0801X- Orthopaedic Trauma
These taxonomies represent providers specializing in orthopedic surgery, including general orthopedics, trauma, and spine surgery.
Related Diagnoses
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M16.0- Bilateral primary osteoarthritis of hip- Indicates degenerative changes affecting both hips, often leading to the need for bilateral hip replacement.
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M16.11- Unilateral primary osteoarthritis, right hip- Refers to primary osteoarthritis affecting only the right hip, commonly resulting in unilateral hip arthroplasty.
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M16.12- Unilateral primary osteoarthritis, left hip- Refers to primary osteoarthritis affecting only the left hip, leading to left-sided hip replacement.
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M16.4- Bilateral post-traumatic osteoarthritis of hip- Describes osteoarthritis in both hips following trauma, which may necessitate bilateral hip arthroplasty.
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M16.5- Unilateral post-traumatic osteoarthritis, right hip- Indicates post-traumatic osteoarthritis in the right hip, often resulting in right-sided hip replacement.
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M16.6- Unilateral post-traumatic osteoarthritis, left hip- Indicates post-traumatic osteoarthritis in the left hip, leading to left-sided hip arthroplasty.
Each diagnosis is clinically relevant as it represents a common indication for performing total hip arthroplasty (27130).
Related CPT Codes
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27132- Conversion of previous hip surgery to total hip arthroplasty- Used when a patient with prior hip surgery (e.g., hemiarthroplasty or other procedure) requires conversion to a total hip replacement.
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27134- Revision of total hip arthroplasty; both components, with or without autograft or allograft- Used for revision surgery involving both the acetabular and femoral components of a previously placed total hip prosthesis.
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27137- Revision of total hip arthroplasty; acetabular component only, with or without autograft or allograft- Used when only the acetabular component of a total hip prosthesis requires revision.
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27138- Revision of total hip arthroplasty; femoral component only, with or without allograft- Used when only the femoral component of a total hip prosthesis requires revision.
These codes are related to 27130 as they represent alternative or subsequent procedures in the clinical workflow of hip arthroplasty. 27132 may be used as an alternative when converting prior surgery, while 27134, 27137, and 27138 are used for revision surgeries following initial total hip arthroplasty. These codes are not typically billed together with 27130 but may be used in the same patient over time as clinical needs evolve.
National Reimbursement Benchmarks
National mean rates for CPT code 27130 show a significant gap between Medicare and commercial payers. Medicare's mean rate is $1,178.38, while the BUCA (average commercial) mean rate is $1,785.09, reflecting a difference of $606.71. UnitedHealth Group and Cigna report the highest mean rates among commercial payers, at $2,452.73 and $2,231.47 respectively.
Rate dispersion varies notably across payers. Medicare has the tightest range, with a difference of $88.00 between its 75th and 25th percentiles, indicating relatively consistent reimbursement. In contrast, UnitedHealth Group exhibits the widest dispersion, with a $1,363.50 gap between its 75th and 25th percentiles, suggesting greater variability in rates. Cigna and Blue Cross Blue Shield also show substantial ranges, at $1,286.50 and $857.06 respectively.
The table and chart below present the full breakdown of national benchmarks for CPT code 27130 by payer, including mean rates and percentile values.
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