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    OpenPayerBilling CodesRepair, Revision, and/or Reconstruction Procedures on the Pelvis and Hip JointCPT cpt-27130-total-hip-arthroplasty-both-components
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    CPT 27130: Total Hip Arthroplasty, Both Components

    Medicare pays $1178 and commercial payers pay $6615 on average nationally for this procedure.

    CPT code 27130 describes a surgical total hip arthroplasty in which the surgeon replaces both the femoral and acetabular components with a prosthetic hip joint, with or without use of autograft or allograft; this represents an operative orthopedic procedure typically performed in an inpatient or ambulatory surgical center setting for degenerative or post‑traumatic hip disease.

    For related coverage guidance, see recent payer policy updates: Orthopedic Joint Procedures of the Knee for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members, Autologous Chondrocyte Transplantation or Implantation Corporate Medical Policy, Autologous Platelet-Derived Growth Factors (Platelet-Rich Plasma [PRP]).

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    National Reimbursement Benchmarks

    National means for CPT 27130 show a notable split: Medicare’s mean of $1,178.40 sits well below BUCA’s mean commercial level of $6,614.90, indicating that commercial negotiated averages can be roughly five to six times higher than Medicare for this code. Blue Cross Blue Shield and UnitedHealth Group means ($10,100 and $2,420.60 respectively) also sit above Medicare, while Aetna and Cigna cluster closer but still exceed Medicare’s mean.

    Dispersion measured by the interquartile range (P75 minus P25) varies substantially. Blue Cross Blue Shield has the widest IQR at $10,144.10 (P75 $14,433.40 minus P25 $4,290.30), followed by BUCA at $6,413.80 and UnitedHealth Group at $1,432.80. Aetna and Cigna exhibit the tightest spreads, with IQRs of $1,445.00 and $1,446.80 respectively, signaling more concentrated commercial negotiated rates for those payers.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old ambulatory patient with progressive hip pain, decreased range of motion, and radiographic evidence of advanced osteoarthritis presents to an orthopaedic surgeon for evaluation. Conservative management including activity modification, oral analgesics, physical therapy, and intra-articular injections provided inadequate relief. Preoperative evaluation includes medical clearance, optimization of comorbidities (cardiac, pulmonary, diabetes), medication reconciliation (anticoagulation management), and templating for implant size and component orientation. On the day of surgery in an inpatient or outpatient hospital surgical suite or ambulatory surgery center, the patient undergoes anesthesia (general or neuraxial). The orthopaedic surgeon performs a total hip arthroplasty with replacement of both femoral and acetabular components (CPT 27130). Intraoperative documentation records approach (posterior, lateral, or anterior), implant types (cemented or uncemented), use or nonuse of autograft/allograft, estimated blood loss, and any intraoperative complications. Postoperative workflow includes immediate recovery, standardized multimodal analgesia, thromboprophylaxis, early mobilization with physical therapy, and discharge planning (same-day discharge from an ambulatory surgery center or overnight inpatient stay). Follow-up visits assess wound healing, implant positioning on imaging, and functional recovery.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    27132

    Related Modifiers

    10 rows

    ModifierDescriptionWhen to Use
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    81Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207X00000X
    207XX0801X
    207XS0117X
    341600000X
    173000000X
    207VE0102X
    251B00000X
    332BN1400X

    Related ICD-10-CM Codes

    6 rows

    ICD-10-CM CodeDescription
    M16.0Bilateral primary osteoarthritis of hip
    M16.11Unilateral primary osteoarthritis, right hip
    M16.12Unilateral primary osteoarthritis, left hip
    M16.4Bilateral post-traumatic osteoarthritis of hip
    M16.5
    M16.6Other bilateral secondary osteoarthritis of hip

    Related Payer Policy Updates

    Specialty: Orthopedics/Musculoskeletal1 / 3

    10 rows

    PolicyPayerEffective Date
    Orthopedic Joint Procedures of the Knee for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Membersuniverahealthcare2027-01-01
    Autologous Chondrocyte Transplantation or Implantation Corporate Medical Policybcbsvermont2026-12-01
    Autologous Platelet-Derived Growth Factors (Platelet-Rich Plasma [PRP])Cigna2026-10-15
    Metatarsophalangeal Joint ReplacementCigna2026-10-15
    Shoulder Arthroplasty (Total, Partial, Reverse, Revision and Resurfacing)univerahealthcare2026-10-15
    Hip Arthroplasty (partial and total hip replacement)univerahealthcare2026-10-15
    Artificial Lumbar Intervertebral Disc (Lumbar Total Disc Arthroplasty)univerahealthcare2026-10-15
    Osteochondral Grafting of the Kneeuniverahealthcare2026-10-15
    Lumbar Fusion (arthrodesis) with decompressionuniverahealthcare2026-10-15
    Metal-on-Metal Total Hip Resurfacinguniverahealthcare2026-10-15

    Related Codes

    CPT-27097-HAMSTRING-PROXIMAL-RELEASE

    CPT 27097: Proximal Hamstring Release

    CPT-27098-ADDUCTOR-TENDON-TRANSFER-ISCHIAL-REATTACHMENT

    CPT 27098: Adductor Tendon Transfer to Ischium

    CPT-27100-EXTERNAL-OBLIQUE-TRANSFER-HIP-ABDUCTOR-RECONSTRUCTION

    CPT 27100: External Oblique Muscle Transfer to Greater Trochanter

    CPT-27105-PARASPINAL-MUSCLE-TRANSFER-TO-HIP-RECONSTRUCTIVE

    CPT 27105: Paraspinal Muscle Transfer to Hip with Fascial/Tendon Graft

    CPT-27110-ILIOPSOAS-TRANSFER-GREATER-TROCHANTER

    CPT 27110: Iliopsoas Transfer from Lesser to Greater Trochanter

    CPT-27111-ILIOPSOAS-TRANSFER-FEMORAL-NECK-HIP-STABILITY

    CPT 27111: Iliopsoas Transfer to Femoral Neck for Hip Stability

    CPT-27120-ACETABULOPLASTY-HIP-RECONSTRUCTION

    CPT 27120: Acetabuloplasty of Hip Socket

    CPT-27122-ACETABULOPLASTY-AND-FEMORAL-HEAD-RESECTION

    CPT 27122: Acetabuloplasty with Femoral Head Resection

    CPT-27125-FEMORAL-HEAD-REPLACEMENT-HEMIARTHROPLASTY-STABILIZATION

    CPT 27125: Hip Hemiarthroplasty, Femoral Head Replacement

    CPT-27132-REVISION-TOTAL-HIP-ARTHROPLASTY-BOTH-COMPONENTS

    CPT 27132: Revision Total Hip Arthroplasty, Femoral and Acetabular Component Replacement

    Showing 1–10 of 30

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Conversion of previous hip surgery to total hip arthroplasty
    Used when prior hip-preserving or fixation procedures are converted to a total hip arthroplasty during the operative course; may be applicable if prior hardware is removed and converted
    27134Revision of total hip arthroplasty; both components, with or without autograft or allograftApplies when a prior total hip arthroplasty is revised and both femoral and acetabular components are exchanged; distinct from primary 27130 which is initial replacement
    27137Revision of total hip arthroplasty; acetabular component only, with or without autograft or allograftUsed when only the acetabular component of a prior prosthesis is revised
    27138Revision of total hip arthroplasty; femoral component only, with or without allograftUsed when only the femoral component of a prior prosthesis is revised