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 |