CPT 27165 Proximal Femur Osteotomy Reimbursement | OpenPayer

Summary & Overview

CPT 27165: Proximal Femoral Osteotomy for Alignment Correction

CPT code 27165 denotes a proximal femoral osteotomy performed to correct femoral alignment or deformity, often stabilized with internal or external fixation or a cast. This orthopedic surgical code captures corrective procedures in the trochanteric region of the femur and is relevant across care settings where operative bone realignment is indicated. Nationally, the code is important for orthopedics, trauma, and pediatric services where femoral deformity or malalignment requires surgical correction.

Key payers for this coverage review include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for CPT code 27165, typical sites of service, and which payers commonly adjudicate claims for this intervention. The publication summarizes benchmark considerations, common billing modifiers provided in the input, and how the procedure is coded and documented in operative records.

This summary provides clinicians, revenue cycle professionals, and policy analysts with the clinical meaning of the code, its relevance to surgical care pathways, and guidance on where to look for payer-specific policy updates and reimbursement rules. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 27165proximal femur osteotomyorthopedic surgeryosteotomyoperative fixationambulatory surgeryhospital inpatient

Billing Code Overview

CPT code 27165 describes an osteotomy of the proximal femur, involving division of a portion of the femur between the greater and lesser trochanter or just below the lesser trochanter to correct alignment or deformity. The procedure may include application of an internal or external fixation device or a cast to stabilize the osteotomy site.

Service type: Surgical — Orthopedic, Corrective Osteotomy

Typical site of service: Hospital inpatient or outpatient surgical center; may also occur in ambulatory surgical settings depending on clinical complexity and stabilization method

Clinical & Coding Specifications

Clinical Context

A 45-year-old patient with a symptomatic femoral deformity causing malalignment and hip pain presents for surgical correction. The orthopedic surgeon plans a proximal femoral osteotomy (27165) to realign the femur in the region between the greater and lesser trochanters. The preoperative workflow includes imaging (AP and lateral radiographs, possible CT or MRI for deformity planning), preoperative clearance, informed consent documenting risks and benefits, and templating for osteotomy level and fixation. Intraoperatively, the surgeon performs the osteotomy, corrects alignment, and stabilizes the site with internal fixation such as a plate and screws or an intramedullary device; external fixation or a cast may be used when indicated. Postoperative workflow includes immediate recovery, pain and infection prophylaxis, radiographic confirmation of correction, weight-bearing instructions, physical therapy referrals, and follow-up visits for wound checks and radiographic healing assessment.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work or complexity substantially exceeds typical for `27165`.

CPT 27181: Intertrochanteric Osteotomy for Slipped Femoral Epiphysis with Fixation

CPT-27175-SLIPPED-FEMORAL-EPIPHYSIS-TRACTION-MANAGEMENT

CPT 27175: Slipped Femoral Epiphysis, Traction Without Reduction

CPT-27151-ILIAC-AND-FEMORAL-OSTEOTOMY-HIP-REALIGNMENT

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

CPT-27178-CLOSED-REDUCTION-PERCUTANEOUS-PINNING-SLIPPED-FEMORAL-EPIPHYSIS

CPT 27178: Closed Reduction and Percutaneous Pinning for Slipped Femoral Epiphysis

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

CPT 27111: Iliopsoas Transfer to Femoral Neck for Hip Stability

CPT-27138-FEMORAL-COMPONENT-REVISION-HIP-ARTHROPLASTY

CPT 27138: Revision Hip Arthroplasty, Femoral Component

CPT-27134-REVISION-TOTAL-HIP-ARTHROPLASTY-BOTH-COMPONENTS

CPT 27134: Revision Total Hip Arthroplasty, Femoral and Acetabular Components

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

CPT 27125: Femoral Head Replacement (Hemiarthroplasty) for Stabilization

CPT-27097-HAMSTRING-PROXIMAL-RELEASE

CPT 27097: Proximal Hamstring Release

CPT-27147-PELVIC-OSTEOTOMY-WITH-HIP-REDUCTION

CPT 27147: Pelvic Osteotomy with Hip Reduction

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Taxonomy Code	Specialty	Notes
207L00000X	Orthopaedic Surgery	Primary specialty performing proximal femoral osteotomy.
207X00000X	Orthopedic Surgery of the Hip	Subspecialty focus on hip and proximal femur procedures.
208000000X	General Surgery	Occasionally involved in combined procedures or trauma settings.
2080S0122X	Pediatric Orthopedic Surgery	Performs femoral osteotomies in pediatric deformity cases.
207K00000X	Orthopedic Traumatology	Performs osteotomies related to post-traumatic deformity correction.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M21.66`	Other acquired deformity, right lower leg	Proximal femoral osteotomy may be performed to correct acquired deformity affecting femoral alignment on the right.
`M21.67`	Other acquired deformity, left lower leg	Indicates an acquired femoral deformity on the left that can be corrected with `27165`.
`M21.61`	Other acquired deformity, right thigh	Specific to deformity of the thigh/femur; guides surgical indication for osteotomy.
`M21.62`	Other acquired deformity, left thigh	Left-sided thigh deformity commonly addressed with proximal femoral osteotomy.
`Q65.8`	Other congenital deformities of hip (including femoral deformities)	Congenital femoral deformities that may require osteotomy for alignment correction.
`M16.1`	Unilateral primary osteoarthritis of hip	Secondary femoral deformity or malalignment contributing to symptomatic osteoarthritis sometimes addressed with corrective osteotomy in younger patients.
`M84.30`	Stress fracture, unspecified site, unsp	Femoral stress fractures with malalignment or nonunion may require corrective osteotomy and fixation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27245`	Open treatment of femoral fracture, proximal end, including internal fixation, when performed	Performed when osteotomy is combined with fracture fixation or conversion of a fracture nonunion requiring fixation during the same operative episode.
`27486`	Osteotomy, femur, distal, open; with lengthening	Related lower femoral osteotomy that may be performed in staged deformity correction involving both proximal and distal femur.
`20690`	Application, uncemented or porous-coated unipolar or bipolar femoral component; (note: commonly used code for joint arthroplasty components)	May be reported when osteotomy is performed as part of preparation for arthroplasty or when hardware for stabilization includes prosthetic components.
`73030`	Radiologic examination, femur; complete, minimum of two views	Preoperative and postoperative radiographs to plan and confirm osteotomy and fixation position.
`27096`	Open treatment of pelvic fracture, includes internal fixation, when performed	May be reported when pelvic fixation is required in complex proximal femur/pelvis deformity cases during the same operative setting.

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