Summary & Overview
CPT 27458: Femoral Osteotomy with Intramedullary Lengthening Device
CPT code 27458 represents femoral osteotomy with insertion of an intramedullary, externally controllable lengthening device and associated management. This procedure is a specialized orthopedic intervention used to correct limb-length discrepancies, congenital deformities, and certain post-traumatic conditions. Nationally, the code is significant because it captures complex operative work, device management, and longitudinal follow-up that impact surgical resource allocation, hospital utilization, and payer coverage policies.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the procedure, typical sites of service (operating room with inpatient or outpatient follow-up), and the components of care bundled into the code, including imaging and device management. The publication summarizes benchmarking considerations, common billing themes, and recent policy developments affecting coverage and prior authorization practices for limb-lengthening devices and related services. It also highlights implications for documentation, alignment assessments, and scheduling of adjustments tied to device programming.
The analysis is intended for national audiences including clinicians, billing professionals, and payer policy staff seeking a clear, operational summary of CPT code 27458, its clinical scope, and the administrative elements that commonly influence coverage and reimbursement.
Billing Code Overview
CPT code 27458 describes a surgical procedure in which the provider performs an osteotomy of the femur (thigh bone) and inserts an intramedullary lengthening device that can be externally controlled to gradually increase bone length. The service includes intraoperative and postoperative imaging, assessments for alignment, programming and adjustment schedules for the lengthening device, ongoing device management, and, when performed, release of the iliotibial band.
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Service type: Surgical limb lengthening with internal adjustable intramedullary device
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Typical site of service: Inpatient or outpatient surgical setting with perioperative imaging and follow-up clinic visits
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.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
-51 |