Summary & Overview
CPT 27066: Excision of Deep Bone Cyst or Benign Tumor with Reconstruction
Headline: CPT code 27066 defines excision of deep bone cysts or benign tumors of the ilium, symphysis pubis, or greater trochanter with possible autograft reconstruction. Lead: CPT code 27066 captures an open orthopedic procedure to remove benign osseous lesions from pelvic or proximal femoral sites and, when performed, to rebuild the defect using the patient’s own bone. This code is clinically significant for orthopedic surgeons, health plan medical reviewers, and hospital surgical departments because it denotes a definitive surgical intervention that can affect inpatient utilization, operative resource use, and post‑operative follow‑up.
This analysis covers national payment and policy contexts for Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical indications and typical sites of service, common service modifiers, payer coverage patterns, and benchmark considerations. The report outlines how CPT code 27066 is applied in surgical practice, common billing scenarios involving reconstruction with autograft, and areas where prior authorization or documentation of medical necessity commonly arises. Data not available in the input is noted where applicable. The content is intended to inform revenue cycle teams, clinical coders, and policy analysts about the procedural definition, payer landscape, and the types of benchmarks and policy updates relevant to this code.
Billing Code Overview
CPT code 27066 describes a surgical procedure to excise a deep bone cyst or benign tumor from the wing of the ilium, symphysis pubis, or greater trochanter of the femur. The provider may also reconstruct the excised portion of bone using an autograft harvested from the patient.
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Service type: Surgical excision and reconstruction of benign bone lesions
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Typical site of service: Inpatient or outpatient hospital operating room, ambulatory surgical center, or other operative setting where open orthopedic procedures on the pelvis or proximal femur are performed
Clinical & Coding Specifications
Clinical Context
A 38-year-old patient presents with persistent groin pain and a palpable mass near the iliac wing identified on radiographs. Advanced imaging (MRI or CT) demonstrates a well-defined lytic lesion consistent with a benign bone tumor or deep bone cyst of the ilium. After multidisciplinary review, the orthopedic oncology team schedules an operative excision of the lesion under general anesthesia. Intraoperatively, the surgeon gains exposure to the wing of the ilium, excises the cyst/tumor with appropriate margins, performs curettage of the defect, and reconstructs the bony defect using autogenous cancellous bone graft harvested from the ipsilateral iliac crest. Specimens are sent to pathology. The patient is recovered in the post-anesthesia care unit and followed postoperatively with pain control, wound checks, and serial radiographs to evaluate graft incorporation and rule out recurrence.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, or complexity substantially exceeds typical for 27066. |
23 | Unusual anesthesia |