Summary & Overview

CPT 27151: Iliac (Acetabular) and Femoral Osteotomy for Hip Realignment

CPT code 27151 represents a combined iliac (innominate/acetabular) osteotomy with femoral osteotomy to correct acetabular and femoral alignment. This complex orthopedic reconstructive procedure is used to address structural hip deformities that affect joint congruity and function. Nationally, such procedures have implications for surgical practice patterns, facility resources, and payer coverage policies because they are resource-intensive, often require inpatient or ambulatory surgical facility use, and involve postoperative rehabilitation.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise briefing on clinical context and service setting, an overview of payer coverage and common modifiers, and benchmarks for utilization and reimbursement where available. The publication also summarizes relevant coding relationships and procedural considerations to support billing accuracy and policy review. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare27151CPThip osteotomyfemoral osteotomyorthopedic surgerypelvic osteotomysurgical reconstructionambulatory surgical centerhospital surgery

Billing Code Overview

CPT code 27151 describes a combined pelvic and femoral osteotomy procedure in which the surgeon performs an iliac (innominate) osteotomy of the acetabular rim and a femoral osteotomy to correct alignment of the proximal femur. The procedure addresses abnormalities of the hip socket (acetabulum) and femoral alignment by cutting and repositioning portions of the ilium and the femur.

Service type: Orthopedic reconstructive surgery (pelvic and femoral osteotomy)

Typical site of service: Hospital operating room or ambulatory surgical center

Clinical & Coding Specifications

Clinical Context

A pediatric or young adult patient with symptomatic developmental dysplasia of the hip (DDH) or residual acetabular malorientation presents with hip pain, gait abnormality, and limited range of motion despite conservative measures. Imaging (AP pelvis radiographs, frog‑leg lateral, and CT or MRI as needed) demonstrates acetabular dysplasia with an abnormal center‑edge angle and femoral malalignment such as excessive anteversion or varus/valgus deformity. The orthopedic surgical team plans a combined pelvic (iliac/acetabular) osteotomy and femoral osteotomy to reorient the acetabulum and correct femoral alignment.

The clinical workflow includes preoperative evaluation with history, physical exam, templating, and informed consent; pre‑op anesthesia evaluation; intraoperative fluoroscopic guidance for osteotomy cuts and fixation; simultaneous pelvic reorientation (e.g., Salter, Pemberton, or periacetabular style osteotomy depending on anatomy) and corrective femoral osteotomy (derotational/shortening/varus/valgus) with internal fixation (plates/screws); immediate post‑op radiographs; and inpatient recovery with pain control, DVT prophylaxis, and physical therapy planning. Typical site of service is an inpatient or ambulatory surgical center with orthopedic surgery capability and fluoroscopy, commonly performed by pediatric orthopedic surgeons or adult reconstructive hip surgeons for younger patients.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, or intensity substantially exceeds typical for `27151` and documentation supports additional work.
`50`	Bilateral procedure	Use when osteotomies are performed on both hips during the same surgical session.
`62`	Two surgeons	Use when two surgeons of different specialties perform distinct portions of the procedure (e.g., pelvic osteotomy by pediatric ortho and femoral osteotomy by adult hip specialist) and both are documented.
`63`	Procedure performed on infants less than 4 years	Use when patient is an infant under age four and documentation supports this age‑based modifier per payer rules.
`66`	Surgical team approach	Use when a documented surgical team approach is used for complex reconstruction requiring team billing.
`78`	Return to operating room for related procedure during global period	Use when patient returns to OR for a related procedure during the global period of `27151`.
`79`	Unrelated procedure or service by the same physician during the global period	Use when an unrelated procedure is performed during the global period.
`52`	Reduced services	Use when a planned portion of the procedure is not performed or is significantly reduced.
`53`	Discontinued procedure	Use when the procedure is started but discontinued due to extenuating circumstances.
`76`	Repeat procedure by same physician (note: not in provided list)	Data not available in the input.

Taxonomy Code	Specialty	Notes
207X00000X	Orthopedic Surgery	Primary specialty performing pelvic and femoral osteotomies.
2080P0206X	Pediatric Orthopedics	Common specialty for children with DDH requiring `27151`.
207XS0112X	Orthopedic Surgery of the Hip and Knee	Subspecialty focusing on complex hip reconstruction and deformity correction.
2086S0125X	Orthopedic Surgery, Pediatric Traumatology	Relevant when osteotomies are performed for post‑traumatic deformity correction.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Q65.0`	Congenital dislocation of hip, unilateral	Common indication in infants/children for pelvic and femoral osteotomy to restore joint stability and congruence.
`Q65.1`	Congenital dislocation of hip, bilateral	When both hips are affected, may require bilateral pelvic and femoral osteotomies (`27151` with `50`).
`M16.11`	Unilateral primary osteoarthritis of hip, right	In young adults with secondary deformity leading to early osteoarthritis, corrective osteotomies may be considered to delay arthroplasty.
`M16.12`	Unilateral primary osteoarthritis of hip, left	Same relevance for left hip symptomatic deformity contributing to pain and dysfunction.
`M21.61`	Other acquired deformity, right lower limb	Used when acquired femoral deformity necessitates corrective osteotomy.
`M21.62`	Other acquired deformity, left lower limb	Same as above for the left side.
`S72.001A`	Fracture of unspecified part of neck of right femur, initial encounter for closed fracture	Post‑traumatic deformity after fracture healing may require combined iliac and femoral osteotomy for reconstruction.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27130`	Total hip arthroplasty (THA), including acetabular and femoral components	May be performed in adults with end‑stage disease instead of reconstructive osteotomies; not performed concurrently with `27151` but part of the differential surgical pathway.
`27145`	Osteotomy, femoral, proximal, subtrochanteric, including internal fixation, when performed	A femoral osteotomy code often used for proximal femoral corrective osteotomies; selected when the femoral osteotomy portion fits the `27145` descriptor rather than bundled into combined pelvic/femoral codes.
`27146`	Osteotomy, femoral, intertrochanteric, including internal fixation, when performed	Alternative femoral osteotomy code for intertrochanteric corrections that may accompany pelvic osteotomy.
`27125`	Acetabuloplasty, reshape of acetabulum (open)	Used when acetabular contouring or rim trimming is performed as a distinct service in conjunction with pelvic osteotomy.
`20690`	Application, uniplane external fixation system	May be used when external fixation is applied for complex pelvic/femoral stabilization as part of reconstruction.
`27190`	Revision hip arthroplasty, with or without allograft; components removed and replaced	Related to complex hip reconstruction pathways; listed as part of alternative or subsequent reconstructive surgeries.