CPT 27054 Open Hip Synovectomy Reimbursement | OpenPayer

Summary & Overview

CPT 27054: Open Synovectomy of Hip

CPT code 27054 represents an open synovectomy of the hip — an operative procedure in which a surgeon opens the hip joint, inspects the interior, and removes inflamed synovial membrane. Nationally, this code captures a distinct set of invasive orthopedic procedures used for inflammatory or degenerative synovial disease when joint preservation requires direct debridement. The code is relevant across hospital and surgical practice settings and has implications for surgical care pathways, coverage policies, and payment validation.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, expected sites of service, and the scope of services represented by the code. The publication outlines common billing practices and coding considerations, typical sites where the procedure is performed, and payer coverage patterns.

This summary provides the framework for benchmarks and policy updates affecting surgical coding and reimbursement, plus clinical context that clarifies when the procedure is reported. Data not available in the input for specific diagnosis pairings, associated taxonomies, or related codes are noted in relevant sections.

AetnaBlue Cross Blue ShieldCignaUnitedHealthcareMedicareCPT 27054hip synovectomyorthopedic surgeryopen synovectomysurgical codingoperating room proceduresprocedure codinghip joint surgery

Billing Code Overview

CPT code 27054 describes an open surgical procedure in which the provider makes an incision to access the hip joint, explores the joint space, and removes the inflamed synovial membrane lining the joint. This procedure is a synovectomy of the hip performed through an open approach.

Service Type: Open surgical synovectomy

Typical Site of Service: Inpatient or outpatient surgical operating room

Clinical & Coding Specifications

Clinical Context

A typical patient undergoing 27054 is an adult presenting with persistent hip pain, swelling, and decreased range of motion due to inflammatory synovitis or septic arthritis of the hip joint. The patient commonly has failed conservative treatment (rest, NSAIDs, corticosteroid injections, or antibiotics) and diagnostic imaging (X-ray, MRI, or ultrasound) demonstrating joint effusion or synovial hypertrophy. Preoperative workup includes laboratory studies (CBC, ESR/CRP), possible joint aspiration for culture and gram stain, and anesthesia evaluation. The procedure is performed in an operating room or ambulatory surgery center under general or regional anesthesia. The surgeon makes an open incision to expose the hip joint, inspects intra-articular structures, and performs a synovectomy to remove inflamed synovial lining. Intraoperative cultures or biopsy specimens may be obtained. Postoperative care includes pain control, wound care, limited weight bearing as indicated, physical therapy for range of motion and strengthening, and follow-up for pathology or culture results. This procedure may be indicated for inflammatory arthropathies (e.g., rheumatoid arthritis), infectious synovitis after aspiration and antibiotics, or chronic synovial disease refractory to less invasive measures.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than typical (extensive synovectomy, prolonged operative time due to adhesions).

Related Codes

CPT-27050-OPEN-SACROILIAC-JOINT-BIOPSY

CPT 27050: Open Sacroiliac Joint Biopsy, Soft Tissue

CPT-27060-ISCHIAL-BURSA-EXCISION

CPT 27060: Excision of Ischial Bursa

CPT-27075-RADICAL-RESECTION-PELVIC-BONE-TUMOR

CPT 27075: Radical Resection of Pelvic Bone Tumor

CPT-27071-DEEP-PARTIAL-EXCISION-ILIUM-PUBIS-GREATER-TROCHANTER

CPT 27071: Deep Partial Excision of Ilium, Pubis, or Greater Trochanter

CPT-27048-PELVIC-HIP-SUBFASCIAL-SOFT-TISSUE-TUMOR-EXCISION-<5CM

CPT 27048: Pelvic/Hip Subfascial Soft-Tissue Tumor Excision, <5 cm

CPT-27077-RADICAL-RESECTION-INNOMINATE-BONE-TUMOR

CPT 27077: Radical Resection of Innominate Bone Tumor

CPT-27057-HIP-BUTTOCK-COMPARTMENT-FASCIOTOMY-DEBRIDEMENT

CPT 27057: Unilateral Hip/Buttock Fasciotomy with Debridement

CPT-27045-PELVIS-HIP-INTRAMUSCULAR-SOFT-TISSUE-TUMOR-EXCISION-5CM-OR-GREATER

CPT 27045: Excision of Pelvis/Hip Intramuscular Soft Tissue Tumor ≥5 cm

CPT-27052-HIP-OPEN-SOFT-TISSUE-BIOPSY

CPT 27052: Open Biopsy of Hip Soft Tissue

CPT-27076-PELVIC-TUMOR-RADICAL-RESECTION-ILIUM-ACETABULUM

CPT 27076: Radical Resection of Pelvic Tumor (Ilium/Acetabulum)

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Taxonomy Code	Specialty	Notes
`207X00000X`	Orthopaedic Surgery	Primary specialty performing open hip synovectomy.
`208600000X`	General Surgery	May perform hip joint procedures in some settings.
`208800000X`	Family Medicine	Uncommon; may provide perioperative management in ambulatory settings.
`163WL0400X`	Physical Therapist	Provides postoperative rehabilitation and range-of-motion therapy.
`372500000X`	Infectious Disease	Consult for septic arthritis or complicated infectious synovitis.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M00.85`	Other pyogenic arthritis, other site	Septic arthritis of the hip can require open synovectomy and drainage.
`M05.851`	Rheumatoid arthritis of right hip	Inflammatory arthropathy causing synovitis that may need synovectomy.
`M05.852`	Rheumatoid arthritis of left hip	Same relevance for left-sided disease.
`M12.50`	Seronegative spondyloarthropathy, unspecified site	Inflammatory synovitis from seronegative spondyloarthropathies may prompt synovectomy.
`M13.051`	Pain in right hip	Symptom code often present in workup prior to operative synovectomy.
`M13.052`	Pain in left hip	Symptom code for left-sided hip pain leading to surgery.
`M65.861`	Other synovitis and tenosynovitis, right hip	Directly describes synovial inflammation addressed by synovectomy.
`M65.862`	Other synovitis and tenosynovitis, left hip	Left hip equivalent.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27040`	Excision or curettement of lesion of pelvis; open	May be performed if concurrent pelvic or periarticular lesion requires excision during exposure for hip synovectomy.
`27310`	Arthrotomy, shoulder; with exploration, with or without drainage	Example of open joint exploration code for another joint; similar workflow for open exploration of hip using `27054` for synovectomy.
`20610`	Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., shoulder, hip, knee)	Often performed preoperatively for diagnostic aspiration or therapeutic drainage prior to open synovectomy.
`20611`	Arthrocentesis, with ultrasound guidance	Used if image-guided aspiration is performed before planning open synovectomy.
`11042`	Debridement; skin, subcutaneous tissue, and fascia	May be used for wound debridement if concurrent soft tissue infection or necrosis is present at the surgical site.