CPT 27078 Radical Resection Reimbursement | OpenPayer

Summary & Overview

CPT 27078: Radical Resection of Ischial Tuberosity and Greater Trochanter

CPT code 27078 denotes a radical surgical resection of a tumor located at the ischial tuberosity and greater trochanter of the femur, including removal of surrounding healthy tissue margins. This procedure is relevant nationally for oncology and orthopedic surgical practices because it represents an advanced limb-preserving or tumor-control operation with implications for surgical planning, facility resource use, and payer coverage policies. Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find a concise clinical and billing overview of the procedure, typical sites of service, and common coding context. The publication summarizes payer coverage considerations, typical modifier usage where available, and comparisons to related surgical codes to aid coding accuracy. It also outlines benchmarks and policy updates affecting authorization, medical necessity determinations, and postoperative care coverage. Clinical context covers indications for radical resection versus more conservative excision, expected surgical resource needs, and implications for inpatient versus ambulatory settings. Data not available in the input is clearly noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 27078orthopedic oncologyradical tumor resectionfemur surgerysurgical codinghospital surgical servicesoncologic procedurebilling overview

Billing Code Overview

CPT code 27078 describes a radical resection of a tumor involving the ischial tuberosity and greater trochanter of the femur. The procedure involves excision of the tumor along with a margin of adjacent healthy tissue to achieve wide local control.

Service type: Surgical oncologic resection of pelvic/proximal femur bone tumor
Typical site of service: Inpatient or outpatient hospital surgical suite, or specialized ambulatory surgical center for complex orthopedic oncology procedures

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient presents with a progressively enlarging, painful mass involving the proximal femur around the ischial tuberosity and greater trochanter region. Imaging with MRI and CT demonstrates a locally aggressive primary bone tumor measuring several centimeters with cortical involvement and soft tissue extension. A core needle biopsy confirms a malignant primary bone neoplasm (e.g., high-grade osteosarcoma or chondrosarcoma) requiring wide local excision. The surgical oncology and orthopedic oncology teams plan a radical resection of the tumor with removal of several centimeters of margin-bearing healthy tissue, including portions of the proximal femur and adjacent soft tissues, to achieve oncologic clearance. The operative workflow includes preoperative planning with multidisciplinary review, intraoperative neurovascular assessment, possible need for intraoperative frozen section for margin assessment, potential reconstruction or prosthetic placement after resection, postoperative admission for pain control and monitoring, and coordination of adjuvant therapies (chemotherapy or radiation) as indicated by pathology.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the work, time, and effort for the radical resection substantially exceed the typical service.

CPT 27075: Radical Resection of Pelvic Bone Tumor

CPT-27070-SUPERFICIAL-PARTIAL-EXCISION-ILIUM-PUBIS-GREATER-TROCHANTER

CPT 27070: Superficial Partial Excision of Ilium, Pubis, Greater Trochanter

CPT-27041-DEEP-PELVIC-HIP-SOFT-TISSUE-BIOPSY

CPT 27041: Deep Pelvic/Hip Soft-Tissue Biopsy, Intramuscular/Subfascial

CPT-27060-ISCHIAL-BURSA-EXCISION

CPT 27060: Excision of Ischial Bursa

CPT-27059-EXTENSIVE-PELVIS-HIP-SOFT-TISSUE-TUMOR-RESECTION-5CM-PLUS

CPT 27059: Extensive Pelvis/Hip Soft Tissue Tumor Resection, 5 cm or Larger

CPT-27054-OPEN-HIP-SYNOVECTOMY

CPT 27054: Open Synovectomy of Hip

CPT-27065-EXCISION-BENIGN-BONE-LESION-ILIUM-PUBIS-TROCHANTER

CPT 27065: Excision of Superficial Bone Cyst or Benign Tumor

CPT-27067-ILIUM-PUBIS-GREATER-TROCHANTER-BONE-CYST-EXCISION-WITH-AUTOGRAFT

CPT 27067: Excision of Bone Cyst or Benign Tumor with Autograft Reconstruction

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

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

CPT-27049-PELVIC-HIP-SOFT-TISSUE-TUMOR-EXCISION-<5CM

CPT 27049: Pelvic/Hip Soft-Tissue Tumor Excision, <5 cm

Showing 1–10 of 23

23

Taxonomy Code	Specialty	Notes
207XS0102X	Orthopaedic Surgery	Orthopedic oncology surgeons commonly perform radical femoral resections.
207K00000X	Surgical Oncology	Surgical oncologists participate in tumor resections and margin management.
2080P0208X	Orthopedic Surgery - Pediatric	Pediatric orthopedic oncologists perform similar resections in children when applicable.
207L00000X	Vascular Surgery	Vascular surgeons may assist when major neurovascular structures are involved.
208000000X	General Surgery	General surgeons may be involved when soft tissue or pelvic extension requires their expertise.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C41.2`	Malignant neoplasm of pelvic bones, sacrum and coccyx	Primary malignant bone tumors of the pelvis or proximal femur region that may require radical resection extending to the ischial tuberosity.
`C41.4`	Malignant neoplasm of lower end of femur	Malignancies located in the distal femur region; included for femoral tumor contexts though proximal codes may be more specific.
`C40.2`	Malignant neoplasm of long bones of lower limb, proximal femur	Directly relevant for tumors originating in the proximal femur near the greater trochanter/ischial tuberosity.
`M89.0`	Osteonecrosis	Severe degenerative or necrotic bone lesions that may mimic tumors or necessitate radical resection in rare cases.
`D16.4`	Benign neoplasm of pelvic bones	Benign but locally aggressive tumors (e.g., giant cell tumor) that may require wide excision rather than simple curettage.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`19307`	Mastectomy, radical - (note: not directly femoral)	Data not available in the input.
`27511`	Radical resection of tumor with muscle, bone resection, and reconstruction, femur; proximal	Provides an alternative code describing proximal femoral tumor resection and potential reconstruction techniques often performed in similar clinical scenarios.
`20670`	Open treatment of fracture with internal fixation, femur	May be used if intraoperative fixation or reconstruction of the femur is required after tumor resection.
`27370`	Excision, tumor, deep soft tissue of thigh and/or popliteal fossa	Used for excision of deep soft-tissue tumors in adjacent regions; may be performed in conjunction with or as an alternative to radical bone resection.
`20936`	Free osteocutaneous flap with microvascular anastomosis	Used when complex reconstruction with free tissue transfer is required after extensive resection to restore form and function.

OpenPayer