CPT 27091 Removal of Hip Prosthesis Reimbursement | OpenPayer

Summary & Overview

CPT 27091: Removal of Cemented Total Hip Prosthesis

CPT code 27091 designates surgical removal of a total hip prosthesis by breaking methylmethacrylate bone cement, optionally with placement of a temporary spacer. This procedure is an important component of revision hip arthroplasty and prosthesis explantation workflows, often performed for prosthetic failure, infection management, or mechanical complications. Nationally, coding accuracy for explantation procedures affects claims processing, quality measurement, and bundled payment calculations for hip revision episodes.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical and operational overview of the procedure, common billing considerations, and the typical sites of service where 27091 is billed. The publication provides benchmarks and payment context where available, highlights relevant coding relationships, and summarizes policy or coverage factors that commonly influence authorization and reimbursement for hip prosthesis explantation. The material is intended for revenue cycle managers, orthopaedic surgeons, coding professionals, and policy analysts seeking a concise national view of coding and billing implications for explantation of cemented total hip prostheses.

Data not available in the input for specific payer rates, ICD-10 pairings, and associated taxonomies.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare27091CPThip explantationrevision arthroplastyorthopaedicsbone cement removaloperative procedurehospital surgeryambulatory surgery center

Billing Code Overview

CPT code 27091 describes a surgical procedure for removal of a total hip prosthesis by breaking the methylmethacrylate bone cement that secures the implant. The procedure may include placement of a temporary spacer in the evacuated joint space but does not require insertion of a new permanent prosthesis during the same encounter.

Service type: Operative orthopaedic procedure, revision/explantation of hip prosthesis.

Typical site of service: Inpatient or outpatient hospital operating room; ambulatory surgery center when clinically appropriate.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 68-year-old male with a painful, failed total hip arthroplasty presenting with progressive hip pain, loosening of the femoral or acetabular component on radiographs, and/or prosthetic joint infection confirmed by aspiration and culture. The clinical workflow begins with preoperative assessment (history, physical exam, labs including CBC and inflammatory markers, joint aspiration if infection suspected, and imaging). The patient is optimized medically and consented for removal of the total hip prosthesis with extraction of methylmethacrylate bone cement, either as a single-stage or staged procedure. In the operating room under general or regional anesthesia, the orthopedic surgeon performs surgical exposure, disrupts and removes the cement mantle and prosthetic components (27091), irrigates the joint, and may insert an antibiotic spacer if performing a staged revision for infection. Postoperative care includes pain control, DVT prophylaxis, wound monitoring, targeted antibiotics if infection is present, and rehabilitation planning. Typical site of service is an inpatient hospital operating room; ambulatory surgery center use is uncommon when extensive cement removal or two-stage exchange is anticipated.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, and complexity substantially exceed typical for (document specifics).

CPT 27095: Hip Arthrography with Contrast Injection and Anesthesia

CPT-27087-PELVIS-HIP-DEEP-TISSUE-FOREIGN-BODY-REMOVAL

CPT 27087: Removal of Foreign Body, Deep Pelvis or Hip

CPT-27096-SACROILIAC-JOINT-INJECTION-IMAGE-GUIDED

CPT 27096: Sacroiliac Joint Injection with Image Guidance

CPT-27086-SUBCUTANEOUS-FOREIGN-BODY-REMOVAL-PELVIS-HIP

CPT 27086: Removal of Foreign Body from Subcutaneous Pelvis or Hip

CPT-27093-HIP-ARTHROGRAPHY-CONTRAST-INJECTION-NO-ANESTHESIA

CPT 27093: Hip Arthrography Contrast Injection, No Anesthesia

CPT-27090-HIP-PROSTHESIS-REMOVAL

CPT 27090: Removal of Hip Joint Prosthesis, Separate Procedure

27091

Taxonomy Code	Specialty	Notes
`207X00000X`	Orthopaedic Surgery	Primary specialty performing prosthesis and cement removal.
`207XS0103X`	Orthopaedic Surgery of the Hip	Subspecialty focus on hip revision arthroplasty.
`208000000X`	General Surgery	Occasionally involved for complex pelvic or soft-tissue reconstruction.
`363L00000X`	Anesthesiology	Provides general or regional anesthesia for the procedure.
`193200000X`	Infectious Disease	Consultation for management when prosthetic joint infection is present.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`T84.032A`	Mechanical complication of internal right hip prosthesis, initial encounter	Mechanical loosening or failure of a right hip prosthesis leading to removal.
`T84.033A`	Mechanical complication of internal left hip prosthesis, initial encounter	Mechanical loosening or failure of a left hip prosthesis leading to removal.
`T84.50XA`	Infection and inflammatory reaction due to internal joint prosthesis, unspecified, initial encounter	Prosthetic joint infection necessitating prosthesis and cement removal.
`M16.11`	Unilateral primary osteoarthritis of right hip	Underlying joint disease that may have led to original arthroplasty and subsequent revision.
`M16.12`	Unilateral primary osteoarthritis of left hip	As above for the left hip.
`M97.071`	Periprosthetic fracture around internal prosthetic right hip joint, initial encounter for closed fracture	Periprosthetic fracture requiring removal of prosthesis and cement.
`M97.072`	Periprosthetic fracture around internal prosthetic left hip joint, initial encounter for closed fracture	Left-sided periprosthetic fracture indication for removal.
`Z96.641`	Presence of right artificial hip joint	Relevant to history and prior prosthesis presence when planning removal.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27090`	Removal of prosthesis, hip, without replacement, including debridement and removal of cement when performed	Often reported for removal of a hip prosthesis when cement removal does not require the specific technique described in `27091`; differentiates technique or extent of cement removal.
`27092`	Removal of prosthesis, hip, with immediate insertion of new prosthesis (revision hip arthroplasty)	Reported when removal of old prosthesis and cement is followed in the same operation by implantation of a revision prosthesis rather than leaving the space or placing a spacer.
`27093`	Removal of prosthesis, hip, with insertion of antibiotic spacer (staged exchange)	Used when cement and components are removed and an antibiotic spacer is inserted as part of a planned two-stage exchange for infection; often billed in the same session as `27091` contextually when spacer insertion is performed.
`27096`	Open treatment of hip infection, debridement and implant removal (complex cases)	Used for complex debridement procedures related to infected hip prosthesis; may be reported alongside or instead of `27091` depending on documentation and elements performed.
`20610`	Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., hip)	Performed preoperatively for diagnostic aspiration if infection suspected; relevant in preoperative workflow before `27091`.

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