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    OpenPayerBilling CodesRepair, Revision, and/or Reconstruction Procedures on the Femur (Thigh Region) and Knee JointCPT cpt-27458-femoral-lengthening-with-internal-device
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    CPT 27458: Femoral Osteotomy with Intramedullary Lengthening Device

    Medicare pays $1763 on average nationally for this procedure.

    CPT code 27458 describes surgical osteotomy of the femur with insertion of an intramedullary, externally controlled lengthening device for gradual limb lengthening; the service includes intraoperative and postoperative imaging, alignment assessments, management and adjustment scheduling of the lengthening device, and optional release of the iliotibial band. Service type: orthopedic surgical limb-lengthening procedure. Typical site of service: inpatient or outpatient surgical facility depending on patient status and procedure complexity.

    For related coverage guidance, see recent payer policy updates: Implants for Joint Pain, Orthopedic Applications of Stem Cell Therapy, Bone Lengthening (Distraction Osteogenesis).

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adolescent or young adult with a limb-length discrepancy due to congenital conditions (for example, congenital short femur), post-traumatic limb shortening, or growth plate arrest. The patient presents with gait asymmetry, leg-length inequality greater than functional threshold (commonly 2–5 cm depending on age and activity), pain, or functional limitations. Preoperative evaluation includes history and physical, limb-length measurement with standing radiographs, full-length hip-to-ankle alignment films, and CT or MRI if needed for complex deformity planning. Surgical workflow: the orthopedic surgeon performs a distal or diaphyseal femoral osteotomy, implants an intramedullary motorized lengthening nail (internal lengthening device), achieves alignment and fixation, and documents intraoperative imaging and check of device function. Postoperative management includes inpatient pain control and wound care, discharged with an external controller and clear outpatient adjustment schedule for gradual distraction (typically 0.33 mm three times daily or per device protocol). Follow-up visits include radiographic monitoring of regenerate bone formation, adjustment schedule checks, physical therapy for joint mobility and strength, and management of complications such as delayed consolidation, malalignment, joint contracture (may include iliotibial band release), pin or wound issues, and device removal when consolidation is complete. Typical site of service is an acute care hospital or ambulatory surgery center for the index procedure with subsequent outpatient clinic visits and radiographs for lengthening and device management.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    27458Osteotomy, femur, with insertion of internal fixation device; includes internal limb lengthening device insertion and intraoperative imaging and adjustment planningPrimary procedure described (index code) — femoral osteotomy with implantation of an intramedullary lengthening device.
    20690Application of external fixation; complex (e.g., Ilizarov, Taylor Spatial Frame)Alternative or adjunct for staged lengthening or deformity correction when external fixation is indicated rather than internal nail.
    27650Fasciotomy, leg (separate procedure)Performed if compartment syndrome or prophylactic fasciotomy is required during lengthening; related soft-tissue management code.
    20680Removal of external fixation deviceIf initial external fixator is used prior to intramedullary lengthening, removal is coded with this code.
    20670Removal of internal fixation device, femurCode used when the internal lengthening device is surgically removed after consolidation and completion of treatment.
    73030Radiologic examination, femur; single viewBaseline and follow-up radiographs to measure length and evaluate regenerate; multiple views and full-length films billed as appropriate.

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    92Modifier 92 (Alternative Laboratory Platform Testing) is used when laboratory tests are performed with single‑use, disposable, portable kits or transportable instruments. The AMA defines it for tests…- Use modifier 92 when a laboratory test is performed using a single‑use, disposable analytical device or kit (an alternative laboratory platform) that is portable and may be taken to or near the…
    93Modifier 93 denotes that a billed service was delivered synchronously via audio-only telecommunications (real-time telephone or other audio-only system). The AMA added modifier 93 in CPT Appendix A…- When to use: Apply modifier -93 when a synchronous, real-time, two-way patient–provider encounter is conducted entirely via audio-only (telephone or other real-time interactive audio-only…
    96Modifier 96 is appended to CPT codes to indicate that a service or procedure was provided for habilitative purposes — i.e., to help a patient learn, maintain, or improve skills and functioning for…- Use modifier -96 when a procedure or service that could be either habilitative or rehabilitative is provided specifically for habilitative purposes — i.e., to help a patient learn, maintain, or…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…
    97Modifier 97 is an informational modifier used with therapy CPT codes to indicate services are rehabilitative — intended to restore skills or function lost due to illness, injury, or disability. It is…- Use modifier 97 when reporting therapy services that are rehabilitative in nature — i.e., provided to restore skills or function lost or impaired because of illness, injury, or disability (for…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207L00000X
    207LP2900X
    2080P0006X
    364S00000X
    207K00000X
    332H00000X
    207QG0300X
    282NC0060X

    Related ICD-10-CM Codes

    20 rows

    ICD-10-CM CodeDescription
    M20.11Hallux valgus (acquired), right foot
    M20.12Hallux valgus (acquired), left foot
    M84.451APathological fracture, right femur, initial encounter for fracture
    M84.452APathological fracture, left femur, initial encounter for fracture
    M84.453APathological fracture, unspecified femur, initial encounter for fracture
    M84.454APathological fracture, pelvis, initial encounter for fracture
    M84.459APathological fracture, hip, unspecified, initial encounter for fracture
    M84.461APathological fracture, right tibia, initial encounter for fracture
    M84.462APathological fracture, left tibia, initial encounter for fracture
    M84.463APathological fracture, right fibula, initial encounter for fracture

    Showing 1–10 of 20

    Related Payer Policy Updates

    Specialty: Orthopedics/Musculoskeletal1 / 3

    10 rows

    PolicyPayerEffective Date
    Implants for Joint PainBlue Cross Blue Shield - Rhode Island2027-03-01
    Orthopedic Applications of Stem Cell TherapyBlue Cross Blue Shield - Rhode Island2027-01-01
    Bone Lengthening (Distraction Osteogenesis)Blue Cross Blue Shield - North Dakota2027-01-01
    Orthopedic Joint Procedures of the Knee for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Membersuniverahealthcare2027-01-01
    Sacroiliac Joint Fusion for the Treatment of Adult Low-Back Pain Medical PolicyHealth-New-England2026-12-01
    Bone Grafts and Stabilization Devices for Spinal Defects - Medical PolicyHealth-New-England2026-12-01
    Implantable Shock Absorbers for Treatment of Knee Osteoarthritisblue cross blue shield - louisiana2026-12-01
    Autologous Chondrocyte Transplantation or Implantation Corporate Medical Policybcbsvermont2026-12-01
    Cartilage Implants for Joint Painpremerabluecrossofwashington2026-11-06
    Cartilage Implants for Joint Painpremerabluecrossofwashington2026-11-06

    Related Codes

    CPT-27380-INFRAPATELLAR-TENDON-PRIMARY-REPAIR

    CPT 27380: Primary Repair of Infrapatellar (Patellar) Tendon

    CPT-27381-SECONDARY-INFRAPATELLAR-TENDON-REPAIR

    CPT 27381: Secondary Repair of Infrapatellar Tendon

    CPT-27385-HAMSTRING-QUADRICEPS-RUPTURE-REPAIR-SUTURE

    CPT 27385: Primary Repair of Hamstring or Quadriceps Rupture

    CPT-27386-SECONDARY-QUADRICEPS-HAMSTRING-REPAIR-AUTOGRAFT

    CPT 27386: Secondary Repair of Quadriceps or Hamstring with Graft

    CPT-27390-OPEN-TENOTOMY-HAMSTRING-SINGLE-TENDON

    CPT 27390: Open Tenotomy of Hamstring Tendon

    CPT-27391-OPEN-HAMSTRING-TENOTOMY

    CPT 27391: Open Tenotomy of Multiple Hamstring Tendons

    CPT-27392-OPEN-TENOTOMY-HAMSTRING-BILATERAL

    CPT 27392: Open Bilateral Hamstring Tenotomy

    CPT-27393-HAMSTRING-TENDON-LENGTHENING

    CPT 27393: Hamstring Tendon Lengthening

    CPT-27394-HAMSTRING-TENDON-LENGTHENING-UNILATERAL

    CPT 27394: Hamstring Tendon Lengthening, Unilateral

    CPT-27395-HAMSTRING-TENDON-LENGTHENING-BILATERAL

    CPT 27395: Bilateral Hamstring Tendon Lengthening

    Showing 1–10 of 59

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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