CPT 27356 Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

CPT 27356: Femoral Tumor or Cyst Excision with Allograft Reconstruction

CPT code 27356 represents surgical excision of a benign bone tumor or cyst from the femur with allograft reconstruction to repair the resulting defect. This procedure addresses pain, mechanical instability, or impaired range of motion caused by focal bony lesions and is relevant to orthopedic surgeons, hospital surgical services, and payers covering musculoskeletal oncology and reconstructive procedures. Nationally, the code matters because it captures a specialized operative service with implications for inpatient and outpatient surgical capacity, reimbursement for graft material, and post-operative care pathways.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for 27356, typical sites of service, and the kinds of services reported under the code. The publication summarizes common billing modifiers and payer considerations, highlights benchmark elements where available, and outlines relevant policy or coding updates affecting coverage and documentation. The content is intended to inform coders, practice managers, and health policy professionals about the role of 27356 in surgical care and billing workflows. Data not available in the input: associated taxonomies, specific ICD-10 diagnoses, and related codes.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare27356CPTorthopedic surgeryfemurallografttumor excisionambulatory surgeryhospital operating room

Billing Code Overview

CPT code 27356 describes a surgical procedure to remove a benign tumor or cyst from the femur with reconstruction using an allograft. The service involves excision of the lesion and placement of donor bone graft material to repair the defect and restore structural integrity.

Service type: Orthopedic surgical procedure for tumor/cyst excision with allograft reconstruction
Typical site of service: Hospital operating room or ambulatory surgery center

Clinical & Coding Specifications

Clinical Context

A typical patient is a 25–40-year-old adult presenting with progressive unilateral thigh pain, localized swelling, or limitation of hip or knee range of motion. Imaging (plain radiographs and MRI or CT) demonstrates a benign-appearing lytic lesion or unicameral bone cyst within the femoral metaphysis or diaphysis that is enlarging or at risk for pathological fracture. After orthopedic oncology or musculoskeletal surgery consultation, the patient is scheduled for surgical curettage of the benign tumor or cyst with placement of an allograft to fill the defect and restore structural integrity.

Preoperative workflow includes history and physical, review of imaging, informed consent addressing risks (infection, graft failure, fracture), preoperative labs and anesthesia evaluation. Intraoperative steps typically include patient positioning, surgical exposure of the femur, lesion curettage, any adjuvant local treatment (e.g., high-speed burr, phenol or cryotherapy if indicated), preparation and impaction of allograft into the defect, and fixation if mechanical stability requires implants. Postoperative workflow includes radiographic confirmation of graft placement, pain control, weight-bearing restrictions or protected mobilization per surgeon preference, and follow-up radiographs to monitor graft incorporation. Rehabilitation and return-to-activity plans are individualized based on lesion size, fixation, and graft incorporation.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services

CPT 27357: Femoral Bone Cyst Excision with Autograft

CPT-27327-SUBCUTANEOUS-TUMOR-EXCISION-THIGH-KNEE

CPT 27327: Excision of Subcutaneous Tumor, Thigh/Knee (<3 cm)

CPT-27333-KNEE-PARTIAL-MENISCECTOMY-MEDIAL-AND-LATERAL

CPT 27333: Knee Partial Meniscectomy, Medial and Lateral

CPT-27339-EXCISION-INTRAMUSCULAR-THIGH-KNEE-TUMOR-5CM-PLUS

CPT 27339: Excision of Intramuscular Thigh or Knee Tumor ≥5 cm

CPT-27331-KNEE-ARTHROTOMY-BIOPSY-LOOSE-BODY-REMOVAL

CPT 27331: Knee Arthrotomy with Synovial Biopsy and Loose Body Removal

CPT-27358-ORTHOPEDIC-INTERNAL-FIXATION-ADD-ON

CPT 27358: Orthopedic Internal Fixation Add-On Procedure

CPT-27347-KNEE-MENISCAL-CAPSULAR-LESION-EXCISION

CPT 27347: Excision of Meniscal or Capsular Knee Lesion

CPT-27326-POPLITEAL-GASTROCNEMIUS-NERVE-EXCISION-FOR-SPASM

CPT 27326: Popliteal/Gastrocnemius Nerve Excision to Relieve Spasm

CPT-27364-EXTENSIVE-EXCISION-SOFT-TISSUE-TUMOR-THIGH-KNEE-5CM-PLUS

CPT 27364: Extensive Excision of Soft Tissue Tumor, Thigh or Knee ≥5 cm

CPT-27328-INTRAMUSCULAR-THIGH-KNEE-TUMOR-EXCISION-SMALL

CPT 27328: Excision of Intramuscular Tumor of Thigh or Knee (<5 cm)

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Taxonomy Code	Specialty	Notes
207X00000X	Orthopaedic Surgery	Primary specialty performing curettage and allograft of femoral benign lesions.
2080P0207X	Orthopaedic Oncology	Surgeons with oncology focus for complex or atypical bone tumors.
208000000X	General Surgery	May be involved in multidisciplinary care in some centers.
207K00000X	Pediatric Orthopaedic Surgery	Pediatric specialists for juvenile bone cysts or lesions.
207L00000X	Hand Surgery	(Not typical for femur) Data not available in the input.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M84.4X0`	Pathological fracture, femur, unspecified site, initial encounter for closed fracture	Lesions that weaken the femur can present with or lead to pathological fracture requiring curettage and grafting.
`M85.86`	Other specified disorders of bone, lower leg	Captures non-specific benign bone disorders of the femur relevant when a precise tumor code is not established.
`D16.4`	Benign neoplasm of bone and articular cartilage of lower limb, including pelvis	Primary code for benign bone tumors of the femur such as osteochondroma or non-ossifying fibroma.
`M89.9`	Disorder of bone, unspecified	Used when specific diagnosis is not yet confirmed but operative management for a benign lesion is performed.
`M85.8`	Other specified disorders of bone	Alternative for specified benign bone conditions requiring structural grafting.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27130`	Open treatment of femoral head or neck fracture, includes internal fixation when performed	May be performed if lesion has caused or is associated with fracture requiring fixation in conjunction with curettage and grafting.
`27075`	Curettage, femoral shaft and proximal femur, without allograft	Related code for curettage alone; use when no graft is placed.
`20930`	Allograft, morselized, or structural, for spine or major weight-bearing bones, first graft	Billed when allograft material is placed to reconstruct the femoral defect created during `27356`.
`20680`	Removal of implant; deep	Performed if prior hardware must be removed during access to lesion before curettage and grafting.
`77002`	Fluoroscopic guidance for long bone positioning (intraoperative)	Used for intraoperative imaging guidance during placement of graft or fixation adjuncts.

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