CPT 27187 Femoral Neck Fixation Reimbursement | OpenPayer

Summary & Overview

CPT 27187: Femoral Neck and Proximal Femur Fixation

CPT code 27187 identifies surgical fixation of defects in the femoral neck and proximal femur using implants such as nails, plates, or screws, with optional use of methylmethacrylate bone cement. This code captures procedures intended to stabilize anatomic defects and prevent future structural failure or deformity, making it relevant to orthopedic trauma, oncology-related reconstructions, and complex degenerative reconstructions. Nationally, accurate coding of these procedures affects hospital billing, case mix reporting, and quality measurement for hip-preserving and reconstructive services.

Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical intent and common service settings, comparisons of payer coverage patterns where available, and contextual benchmarks related to utilization and site-of-service. The publication also outlines common modifiers seen with surgical procedures of this type and situates CPT code 27187 within related orthopedic procedure coding to aid billing and coding teams.

The report is organized to provide quick-reference benchmarks, policy and coverage highlights, and clinical context for coding decisions. Data not available in the input (for example, specific payer policy language, diagnosis pairings, and utilization metrics) are noted where relevant elsewhere in the publication.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 27187orthopedic surgeryfemoral neck fixationhip reconstructionsurgical fixationbone cementambulatory surgeryhospital inpatient

Billing Code Overview

CPT code 27187 describes surgical treatment of a defect in the femoral neck and proximal femur using internal fixation devices such as intramedullary nails, plates, or screws. The procedure may include the use of methylmethacrylate bone cement but does not require it.

Service type: Orthopedic surgical fixation of femoral neck/proximal femur defect
Typical site of service: Inpatient or outpatient hospital operating room or ambulatory surgical center depending on patient status and procedural complexity

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with symptomatic weakening or a structural defect of the femoral neck and proximal femur due to a non-displaced insufficiency fracture, prior failed fixation with hardware loosening, tumor-related bone loss, or a localized osteolytic lesion. The patient commonly presents with progressive groin or lateral hip pain, difficulty weight-bearing, and reduced range of motion. Imaging with radiographs and CT or MRI demonstrates cortical defect, femoral neck cortical compromise, or proximal femoral bone loss requiring surgical stabilization.

The clinical workflow includes preoperative evaluation (history, physical, and imaging), medical optimization and anesthesia clearance, informed consent that discusses fixation options and potential use of polymethylmethacrylate (bone cement), intraoperative fixation of the femoral neck and proximal femur using plates, screws, or intramedullary nails with or without cement augmentation, and immediate postoperative radiographs to confirm hardware position. Postoperative care involves pain control, thromboprophylaxis as indicated, weight-bearing instructions (often partial or protected weight-bearing), and outpatient follow-up with serial imaging to assess healing and hardware integrity. Typical sites of service are the hospital operating room or ambulatory surgery center depending on complexity and patient comorbidity.

Coding Specifications

Modifier	Description	When to Use
`50`	Bilateral procedure

CPT 27146: Pelvic Osteotomy — Iliac/Acetabular/Innominate Bone

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

CPT 27105: Paraspinal Muscle Transfer to Hip, Reconstructive Procedure

CPT-27110-ILIOPSOAS-TRANSFER-GREATER-TROCHANTER

CPT 27110: Iliopsoas Transfer to Greater Trochanter

27132-CONVERSION-OF-PREVIOUS-HIP-SURGERY-TO-TOTAL-HIP

CPT 27132: Conversion to Total Hip Arthroplasty

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

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

CPT-27179-FEMORAL-NECK-OSTEOTOMY-SLIPPED-EPIPHYSIS

CPT 27179: Femoral Neck Osteotomy for Slipped Femoral Epiphysis

CPT-27120-ACETABULOPLASTY-HIP-RECONSTRUCTION

CPT 27120: Acetabuloplasty, Surgical Reshaping of the Hip Socket

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

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

CPT-27156-PELVIC-AND-FEMORAL-OSTEOTOMY-HIP-REDUCTION

CPT 27156: Pelvic and Femoral Osteotomy with Hip Reduction

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

CPT 27098: Adductor Tendon Transfer to Ischium

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Taxonomy Code	Specialty	Notes
207X00000X	Orthopaedic Surgery	Primary specialty performing femoral neck / proximal femur fixation procedures.
2080P0208X	Orthopaedic Trauma	Surgeons specializing in fracture care and complex proximal femur reconstructions.
2083N0400X	Surgical Oncology	In cases with tumor-related bone loss requiring fixation and possible cement augmentation.
207K00000X	Physical Medicine & Rehabilitation	Involved in postoperative functional recovery and rehabilitation planning.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M84.351A`	Stress fracture, right femur, initial encounter for fracture	Stress or insufficiency fractures of the femoral neck that may require fixation to prevent collapse.
`M84.352A`	Stress fracture, left femur, initial encounter for fracture	Left-sided counterpart for femoral neck insufficiency fractures requiring stabilization.
`S72.001A`	Fracture of unspecified part of neck of right femur, initial encounter for closed fracture	Acute femoral neck fractures treated with internal fixation to restore stability.
`S72.002A`	Fracture of unspecified part of neck of left femur, initial encounter for closed fracture	Left femoral neck acute fracture indication for fixation.
`M84.359A`	Pathologic fracture in neoplastic disease, unspecified femur, initial encounter	Pathologic bone loss or tumor-related defects in proximal femur that necessitate fixation and possible cement augmentation.
`M80.061A`	Age-related osteoporosis with current pathological fracture, right femur, initial encounter	Osteoporotic bone leading to femoral neck insufficiency requiring fixation and augmentation.
`M80.062A`	Age-related osteoporosis with current pathological fracture, left femur, initial encounter	Left-sided osteoporotic pathologic fracture managed with fixation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27130`	Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty)	May be performed when the femoral neck/proximal femur defect is not reconstructible and replacement is indicated instead of fixation.
`27236`	Open treatment of femoral fracture, proximal end, including internal fixation, when performed, without prosthetic replacement	Alternative or adjunct fixation code for proximal femoral fractures; may be used when fixation technique differs from `27187`.
`20680`	Removal of deep implant, with or without incision and drainage, including proximal femoral hardware removal	Performed when prior failing hardware must be removed before definitive fixation.
`20930`	Allograft, morselized or placement of osteobiologic adjunct, proximal femur	Used when bone grafting or biologic augmentation accompanies fixation for structural defects.
`77071`	Ultrasound, bone healing (if performed)	May be used postoperatively for monitoring or adjunctive bone healing therapies in select patients.

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