Summary & Overview
CPT 27067: Excision of Bone Cyst or Benign Tumor with Autograft Reconstruction
CPT code 27067 covers surgical removal of a bone cyst or benign tumor from pelvic sites (wing of the ilium, symphysis pubis) or the greater trochanter of the femur, with immediate reconstruction using an autogenous bone graft harvested from the patient. This code matters nationally because it captures complex orthopedic oncologic and reconstructive work that affects procedural coding, payment policy, and utilization monitoring for hospitals and surgical centers.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The coverage and payment approaches across these payers influence where and how these procedures are performed, billing practices for combined excision plus grafting services, and audit risk for correct code selection.
Readers will find a concise clinical and billing overview, typical sites of service, commonly attached modifiers, and the scope of services embodied by the code. The publication also outlines benchmarks and policy-relevant considerations for payers and providers, including coding clarity for excision plus autograft reconstruction, implications for facility versus professional billing, and elements relevant to prior authorization and claims review. Data not available in the input for payer-specific rates, utilization metrics, and associated ICD-10 diagnoses are noted.
Billing Code Overview
CPT code 27067 describes surgical excision of a bone cyst or benign tumor from the wing of the ilium, symphysis pubis, or greater trochanter of the femur, followed by immediate reconstruction of the excised bone using an autogenous graft harvested from another site through a separate incision.
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Service type: Surgical excision with autograft reconstruction
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Typical site of service: Hospital operating room or ambulatory surgical center for orthopedic oncology or orthopedic reconstructive procedures
Clinical & Coding Specifications
Clinical Context
A 34-year-old otherwise healthy male presents with progressive left lateral hip pain and a palpable mass over the greater trochanter area. Imaging (radiograph and MRI) demonstrates a benign-appearing bone lesion consistent with a unicameral bone cyst occupying the greater trochanter with cortical thinning and risk of pathologic fracture. After preoperative evaluation and informed consent, the orthopedic surgeon schedules an operative procedure under general anesthesia. The surgeon performs an excision of the cystic lesion from the greater trochanter and harvests an autologous cancellous bone graft from the ipsilateral iliac crest through a separate incision to reconstruct and fill the defect. Intraoperative radiographs confirm satisfactory graft placement and cortical integrity. The patient is monitored in the post-anesthesia care unit and discharged with activity restrictions, pain control, and follow-up for wound checks and radiographic surveillance.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased Procedural Services | Use when documented work, time, and complexity of excision and graft harvest exceed typical for 27067 (extensive dissection, unusually large defect). |
23 |