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    OpenPayerBilling CodesAmputation Procedures on the Femur (Thigh Region) and Knee JointCPT cpt-27591-transfemoral-amputation-immediate-prosthesis
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    CPT 27591: Transfemoral Amputation with Immediate Prosthesis

    Medicare pays $904 on average nationally for this procedure.

    CPT code 27591 describes a surgical transfemoral amputation in which the provider removes the leg at any level of the femur and closes the residual limb with muscle and skin layers, with immediate fitting of a prosthesis to facilitate early mobilization; service type: major lower extremity surgical amputation with immediate prosthetic fitting; typical site of service: inpatient hospital or ambulatory surgical center where surgical amputation and prosthetic placement are performed.

    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 a middle-aged or older adult who presents with a nonviable or severely compromised lower extremity at or proximal to the femur due to trauma, ischemia, infection, malignancy, or failed limb salvage. The clinical workflow begins with emergency or scheduled preoperative evaluation including history, physical exam, vascular and infection assessment, imaging (X-ray, CT, or MRI as indicated), and laboratory testing. Multidisciplinary planning involves orthopedic or vascular surgeons, anesthesiology, rehabilitation medicine, and prosthetics. The procedure 27591 describes a transfemoral (above-knee) amputation with complete removal of the leg at any level of the femur and immediate fitting of a temporary or definitive prosthesis to facilitate early mobilization. Intraoperative steps include femoral osteotomy, soft tissue and muscle flap formation, meticulous hemostasis, and layered closure. Postoperative care includes pain control, stump care and protection, early physical therapy and gait training with the immediate prosthetic fit, wound surveillance, and coordinated discharge planning with outpatient prosthetics and rehabilitation services. Typical sites of service are the hospital operating room for inpatient or same-day surgery and specialized surgical centers equipped for major amputations. Expected clinical indications include ischemic limb with gangrene, severe crush or traumatic limb loss, refractory osteomyelitis, or locally advanced malignancy involving the femur or soft tissues where limb preservation is not possible.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    27591(Primary code described) Removal of the leg at any point on the femur with immediate prosthesis fitting (transfemoral amputation with immediate prosthesis)Primary procedure for above-knee amputation with immediate prosthetic fitting to enable early mobilization.
    11042Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or lessMay be performed preoperatively or intraoperatively for extensive soft-tissue debridement in infected or necrotic limbs prior to or concurrent with amputation.
    11043Debridement, muscle and/or fascia, first 20 sq cm or lessUsed when deeper infected or necrotic tissue debridement is required in the limb during the same operative session.
    27600Amputation, leg, through tibia and fibula; any level (symmetry for lower leg)Represents lower-level amputations; relevant when documentation must distinguish level of amputation or when multiple levels are considered.
    29900Arthroscopy, knee, diagnosticOccasionally performed in preoperative assessment of knee joint pathology if relevant to stump formation or surgical planning.
    29999Unlisted procedure, arthroscopyPlaceholder when adjunct procedures not otherwise coded are performed during the same operative episode.

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207L00000X
    2084P0800X
    2471V0106X
    261QM1300X
    2081P0010X
    2081N0008X
    2279P3800X
    101YS0200X

    Related Payer Policy Updates

    Specialty: Orthopedics/Musculoskeletal1 / 2

    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-27590-FEMORAL-AMPUTATION-ABOVE-KNEE

    CPT 27590: Amputation of Leg Through Femur

    CPT-27592-FEMORAL-TRANSSECTION-FOR-INFECTION-CONTROL

    CPT 27592: Complete Femoral Amputation (Through Femur)

    CPT-27594-HIGH-FEMORAL-AMPUTATION-SECONDARY-CLOSURE

    CPT 27594: Transfemoral (Above-Knee) Amputation with Secondary Closure

    CPT-27596-FEMORAL-STUMP-SHORTENING-AMPUTATION-REVISION

    CPT 27596: Femoral Amputation Residual Limb Shortening

    CPT-27598-LOWER-LEG-DISARTICULATION-PRESERVING-FEMORAL-END

    CPT 27598: Lower Leg Amputation Separating Tibia/Fibula From Femur

    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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