Summary & Overview
CPT 27005: Open Tenotomy of Hip Flexor Muscles
CPT code 27005 identifies an open tenotomy of one or more hip flexor muscles — a focused orthopedic surgical procedure to release contracted tendons. This code is used in billing for operative management of hip flexor tightness or deformity and is relevant to hospitals, ambulatory surgery centers, and orthopedic surgical practices nationwide. Accurate use of the code affects claims processing, appropriate setting of care, and procedural tracking across payers.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides clinical context for the procedure, outlines common payer coverage considerations, and summarizes expected sites of service. Readers will find benchmarks and coding guidance related to service classification, expected procedural settings, and common modifier usage (listed separately), as well as a concise review of documentation elements that support medical necessity.
This summary serves national stakeholders — clinicians, coders, and administrators — seeking a clear reference for CPT code 27005, its clinical role in orthopedic surgery, and the payer landscape affecting reimbursement and claims adjudication. Data not available in the input is noted where applicable in detailed sections.
Billing Code Overview
CPT code 27005 describes an open tenotomy of one or more flexor muscles of the hip, a surgical procedure in which the provider performs a deliberate division of tendon tissue to release tight or contracted hip flexor muscles. The procedure is categorized as an operative musculoskeletal service focused on tendon management.
Service type: Surgical — Orthopedic/Procedural
Typical site of service: Operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with hip flexor contracture or spasticity (for example post-stroke, cerebral palsy, or chronic hip flexor tendon shortening) who presents with limited hip extension, gait disturbance, or pain and has failed conservative care including physical therapy, stretching, orthotic management, and medication. After clinical evaluation and imaging as appropriate (hip radiographs, ultrasound or MRI if indicated), the orthopedic or neurosurgical team schedules an open tenotomy of one or more hip flexor tendons (commonly the iliopsoas or rectus femoris) to release contracture and improve range of motion.
The clinical workflow includes preoperative assessment (history, focused musculoskeletal and neurologic exam, anesthesia evaluation), informed consent documenting procedure and expected outcomes, perioperative antibiotic prophylaxis per facility policy, intraoperative open tendon division under general or regional anesthesia in an operating room or ambulatory surgery center, immediate postoperative monitoring for pain control and neurovascular status, and a discharge plan that includes physical therapy, activity restrictions, and follow-up for wound check and functional assessment. Typical site of service is an operating room in an acute care hospital or an ambulatory surgery center. Service type: Surgical – open tendon release of hip flexor muscles.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |