CPT 27036 Hip Capsule Release Reimbursement | OpenPayer

Summary & Overview

CPT 27036: Hip Capsule Release and Excision of Heterotopic Bone

CPT code 27036 represents a surgical intervention on the hip joint capsule, commonly used to remove heterotopic bone and release contracted hip flexor muscles to restore range of motion and reduce pain. Nationally, procedures addressing heterotopic ossification and periarticular contractures are important for trauma, neurologic injury, and post‑operative rehabilitation populations, and the code supports tracking utilization of targeted orthopedic surgical care.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the procedure, typical sites of service, and which payer types commonly cover such surgical interventions. The publication outlines benchmarks and coverage considerations where available, summarizes common billing modifiers used with this procedure, and highlights clinical circumstances that typically prompt use of the code.

This resource is designed for billing managers, revenue integrity teams, and clinical coders seeking clarity on service definition, expected settings of care, and payer coverage landscape. Data not available in the input will be noted where applicable; the content focuses on national relevance and practical coding context rather than state‑level variations.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare27036CPThip surgeryheterotopic ossificationorthopedic surgeryambulatory surgeryoperating roomprocedural coding

Billing Code Overview

CPT code 27036 describes a surgical procedure on the hip joint capsule, often performed to excise heterotopic bone and release tight hip flexor muscles. The procedure is a hip capsule release and excision of heterotopic bone, addressing joint restriction and pain caused by abnormal bone formation or soft-tissue contracture.

Service Type: Surgical — Orthopedic/Procedural intervention on the hip joint capsule

Typical Site of Service: Hospital operating room or ambulatory surgery center, where orthopedic surgical procedures and intraoperative management are performed.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 45–70 year-old adult with symptomatic limited hip range of motion, pain, and functional impairment after prior total hip arthroplasty, hip trauma, or prolonged heterotopic ossification following hip surgery. The patient presents to an orthopedic clinic with progressive difficulty flexing the hip, pain with ambulation, and reduced ability to perform activities of daily living despite conservative care (physical therapy, activity modification, and analgesics). Imaging (plain radiographs and CT) demonstrates heterotopic bone limiting hip joint capsule excursion and/or a contracted hip flexor (iliopsoas) tendon causing impingement.

The clinical workflow includes preoperative evaluation by an orthopedic surgeon with review of imaging and medical optimization, informed consent, and scheduling for operative intervention. On the day of service the patient undergoes general or regional anesthesia in an operating room setting at an outpatient surgical center or hospital. The surgeon performs surgical excision of heterotopic ossification and capsular release of the hip, and may release or lengthen the iliopsoas tendon if entrapped. Intraoperative fluoroscopy may be used to confirm adequate resection. Postoperative care includes recovery room monitoring, pain control, early mobilization with physical therapy, and follow-up visits to monitor wound healing and functional recovery. Typical sites of service are hospital outpatient department or ambulatory surgery center.

Coding Specifications

Modifier	Description	When to Use
`22`

CPT 27033: Open Hip Joint Exploration and Foreign Body Removal

CPT-27035-HIP-JOINT-NERVE-DENERVATION-FOR-ARTHRITIS-PAIN

CPT 27035: Hip Joint Nerve Denervation for Arthritis Pain

CPT-26992-PELVIC-HIP-BONE-CORTEX-INCISION-FOR-INFECTION

CPT 26992: Incision of Pelvic or Hip Bone Cortex for Infection

CPT-27005-HIP-FLEXOR-OPEN-TENOTOMY

CPT 27005: Open Tenotomy of Hip Flexor Muscles

CPT-27030-HIP-JOINT-INCISION-EXPLORATION-DRAINAGE-INFECTION

CPT 27030: Hip Joint Incision, Exploration, and Drainage

CPT-27003-ADDUCTOR-TENOTOMY-OBTURATOR-NERVE-REMOVAL

CPT 27003: Open Adductor Tenotomy with Obturator Nerve Removal

CPT-26990-PELVIS-HIP-DEEP-ABSCESS-DRAINAGE

CPT 26990: Incision and Drainage of Deep Pelvic or Hip Abscess

CPT-26991-HIP-BURSA-INCISION-AND-DRAINAGE

CPT 26991: Incision and Drainage of Infected Hip Bursa

CPT-27027-HIP-BUTTOCK-FASCIOTOMY-UNILATERAL

CPT 27027: Unilateral Hip/Buttock Compartment Fasciotomy

CPT-27025-HIP-THIGH-FASCIOTOMY-DECOMPRESSION

CPT 27025: Fasciotomy, Hip or Thigh

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Taxonomy Code	Specialty	Notes
207X00000X	Orthopaedic Surgery	Primary specialty performing hip capsule surgery and heterotopic bone excision.
208000000X	Orthopedic Trauma Surgery	Surgeons who manage complex post‑traumatic heterotopic ossification and revision cases.
363L00000X	Physical Medicine & Rehabilitation	Involved in pre- and post-operative nonoperative management and rehabilitation planning.
207K00000X	Sports Medicine (Orthopedic)	May perform arthroscopic or limited open releases for impingement and contracture management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M24.471`	Contracture, right hip	Hip capsular or muscular contracture limiting range of motion; may necessitate capsular release.
`M24.472`	Contracture, left hip	Same clinical relevance for the left hip.
`M24.459`	Joint stiffness, unspecified hip	Non-specific stiffness that may be due to heterotopic ossification or capsular tightness.
`M24.851`	Other specific joint derangement, right hip	Includes mechanical derangement contributing to pain and limited motion addressed by excision and release.
`M24.852`	Other specific joint derangement, left hip	Left-sided correlate for mechanical derangement.
`M61.0`	Myositis ossificans traumatica	Heterotopic ossification of muscle often requiring excision when symptomatic and limiting function.
`T84.84XA`	Pain due to internal orthopedic prosthetic device, initial encounter	Pain from prosthesis-associated heterotopic ossification or impingement after arthroplasty.
`T84.89XA`	Other complication of internal orthopedic prosthetic device, initial encounter	Captures other post‑arthroplasty complications such as heterotopic ossification necessitating surgical management.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27036`	Excision, soft tissue of hip (eg, heterotopic ossification); with or without muscle/tendon lengthening	Primary procedure: surgical excision of heterotopic bone and release/lengthening of hip flexor or capsule.
`27030`	Arthrotomy, hip; with or without drainage; with debridement	May be performed to access the hip joint for debridement in infection or extensive intra-articular pathology prior to or instead of `27036`.
`27134`	Revision of total hip arthroplasty, acetabular component	Performed when heterotopic ossification or prosthetic issues require component revision in the same operative episode.
`27027`	Fasciotomy, hip (eg, tensor fascia lata)	Performed for compartment or soft-tissue releases in conjunction with capsular release when indicated.
`29827`	Arthroscopy, hip, surgical; with femoroplasty (eg, for cam lesion)	Arthroscopic procedures may be performed before or instead of open excision for intra-articular impingement issues associated with limited range of motion.
`20680`	Removal of implant; deep (e.g., prosthetic material)	Used when removal of hardware is necessary to access heterotopic bone or correct mechanical impingement.

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