Summary & Overview
CPT 27290: Hemipelvectomy with Ipsilateral Lower-Extremity Amputation
CPT code 27290 denotes a hemipelvectomy combined with ipsilateral lower-extremity amputation — a rare, high-complexity operative procedure performed for catastrophic trauma, refractory infection, or locally advanced tumor. Nationally, this code represents one of the most significant surgical interventions in musculoskeletal and oncologic care because of the procedure’s complexity, resource intensity, and implications for postoperative rehabilitation and prosthetic planning. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, payer coverage considerations, and an outline of the expected service setting and care pathway. The publication also highlights common billing modifiers and coding considerations where data are available, operational impacts on inpatient surgical services, and policy or reimbursement factors that typically influence authorization and payment for high-acuity amputative pelvic procedures. Data not available in the input for specific diagnosis mapping, associated taxonomies, and related codes is noted where applicable.
Billing Code Overview
CPT code 27290 describes a radical surgical amputation that removes an entire lower extremity together with one hemipelvis (one outer half of the pelvis) on the same side. This procedure is performed in rare, high-acuity clinical situations such as severe trauma, uncontrolled infection, or locally advanced pelvic or soft-tissue malignancy.
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Service type: Major surgical amputation with pelvic resection
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Typical site of service: Inpatient acute care hospital or specialized tertiary referral center with surgical oncology or trauma capabilities
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult who sustained catastrophic ipsilateral pelvic and lower-extremity injury or has an aggressive pelvic malignancy or uncontrollable pelvic infection requiring removal of the entire lower limb and hemipelvis (external hemipelvectomy). The workflow begins with multidisciplinary assessment by trauma or orthopedic oncology teams, preoperative optimization (hemodynamic stabilization, infection control, imaging, vascular and plastic surgery consults), informed consent discussing functional loss and prosthetic options, and coordination for blood products and perioperative critical care. On the day of surgery, the operative team performs radical resection of the lower extremity and hemipelvis under general anesthesia with arterial and venous control, possible flap reconstruction, and placement of drains. Postoperative care includes ICU monitoring, wound care, pain control, physical medicine and rehabilitation planning, prosthetics referral, and outpatient oncologic or infectious disease follow-up as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Not a real CMS modifier; typically placeholder | Data not available in the input |
11 | Primary or sole E/M or procedure |