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    OpenPayerBilling CodesRepair, Revision, and/or Reconstruction Procedures on the Pelvis and Hip JointCPT cpt-27146-pelvic-osteotomy-iliac-acetabular-innominate-bone
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    CPT 27146: Pelvic Osteotomy of Iliac/Acetabular/Innominate Bone

    Medicare pays $1187 on average nationally for this procedure.

    CPT code 27146 describes an osteotomy of the pelvis involving cutting of the iliac, acetabular, or innominate bone to correct structural abnormalities of the pelvic girdle; the service is an open orthopedic surgical procedure and the typical site of service is an inpatient or outpatient hospital operating room depending on clinical complexity and postprocedural needs.

    For related coverage guidance, see recent payer policy updates: Implants for Joint Pain, Bone Lengthening (Distraction Osteogenesis), Orthopedic Applications of Stem Cell Therapy.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is a 16–30-year-old with symptomatic acetabular dysplasia or malorientation presenting with lateral hip pain, activity-related groin pain, and progressive hip instability. After conservative management (physical therapy, activity modification, NSAIDs, and intra-articular injection) fails, the orthopedic surgeon evaluates imaging including AP pelvis radiographs, CT scan with 3D reconstruction, and MRI to assess acetabular coverage and labral/chondral pathology. When undercoverage or malalignment is identified, the surgeon schedules an open pelvic osteotomy such as a periacetabular osteotomy (ilium/acetabulum osteotomy) to reorient the acetabular socket.

    Preoperative workflow includes history/physical, medical clearance, informed consent documenting indication and laterality, templating, and anesthesia evaluation. In the operating room the patient is positioned supine or lateral, and the provider performs an osteotomy of the iliac, acetabular, or innominate bone to reorient the acetabulum and improve femoral head coverage. Fixation with plates/screws is typically performed and intraoperative fluoroscopy verifies correction. Postoperative care involves inpatient pain control, DVT prophylaxis, limited weight bearing, physical therapy, and follow-up imaging to confirm osteotomy healing.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    27130Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty)May be performed if osteotomy is not indicated or as a staged procedure for advanced degenerative disease.
    27299Unlisted procedure, pelvis or hip jointUsed for pelvic procedures not described by a specific CPT code when an osteotomy variant lacks a distinct code.
    27216Osteotomy, femoral, proximal, with or without internal fixationPerformed when combined femoral and pelvic realignment are required (combined femoral osteotomy and pelvic osteotomy).
    29862Hip arthroscopy, surgical; with femoroplasty (e.g., for cam lesion)May be performed in the same episode to address intra-articular pathology such as labral tears concurrent with acetabular reorientation.
    20690Application of external fixation device (unlisted)May be used if temporary external fixation is required for complex pelvic stabilization during or after osteotomy.
    20936Bone allograft, morselized, or placement of osteobiologic graftUsed when structural bone grafting is required to augment acetabular reconstruction or fill defects created by osteotomy.

    Related Modifiers

    13 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…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    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…
    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…
    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…

    Showing 1–10 of 13

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207X00000X
    2080P0208X
    207L00000X
    207K00000X
    207PE0004X
    207QS0010X
    261QR0400X
    261QR0206X

    Related ICD-10-CM Codes

    17 rows

    ICD-10-CM CodeDescription
    M16.11Unilateral primary osteoarthritis, right hip
    M16.12Unilateral primary osteoarthritis, left hip
    M16.9Osteoarthritis of hip, unspecified
    M20.11Hallux valgus (acquired), right foot
    M20.12Hallux valgus (acquired), left foot
    M24.351Pathological dislocation of right hip, not elsewhere classified
    M24.352Pathological dislocation of left hip, not elsewhere classified
    M25.561Pain in right knee
    M25.562Pain in left knee
    M77.01Medial epicondylitis, right elbow

    Showing 1–10 of 17

    Related Payer Policy Updates

    Specialty: Orthopedics/Musculoskeletal1 / 3

    10 rows

    PolicyPayerEffective Date
    Implants for Joint PainBlue Cross Blue Shield - Rhode Island2027-03-01
    Bone Lengthening (Distraction Osteogenesis)regence2027-01-01
    Orthopedic Applications of Stem Cell TherapyBlue Cross Blue Shield - Rhode Island2027-01-01
    Bone Lengthening (Distraction Osteogenesis)Blue Cross Blue Shield - North Dakota2027-01-01
    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
    Sacroiliac Joint Fusion for the Treatment of Adult Low-Back Pain Medical PolicyHealth-New-England2026-12-01
    Bone Grafts and Stabilization Devices for Spinal Defects - Medical PolicyHealth-New-England2026-12-01
    Implantable Shock Absorbers for Treatment of Knee Osteoarthritisblue cross blue shield - louisiana2026-12-01
    Autologous Chondrocyte Transplantation or Implantation Corporate Medical Policybcbsvermont2026-12-01
    Cartilage Implants for Joint Painpremerabluecrossofwashington2026-11-06

    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-27130-TOTAL-HIP-ARTHROPLASTY-BOTH-COMPONENTS

    CPT 27130: Total Hip Arthroplasty, Both Components

    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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