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Billing code 27165: Femoral osteotomyMedicare rate & RVUs

Reports a corrective cut through the proximal femur at the intertrochanteric or subtrochanteric level, with fixation or casting included in the service.

CMS RVU26DEffective Oct 1, 2026109 payment localities122 Medicare services in 2024

Medicare pays $1,259.55 for 27165 nationally in a facility.

Medicare rate · 27165

Femoral osteotomy

Swap in your local Medicare rate.

Work RVUs
19.78
Total RVUs
37.71
Global days
090

National rate · 2026

$1,259.55

Facility setting, before claim adjustments.

See every locality for 27165 → · Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

On this page 10 sections
  1. Medicare rate
  2. What 27165 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 27165 covers

An orthopedic surgeon performs this operation to change alignment or correct a deformity of the proximal femur by cutting bone at the intertrochanteric or subtrochanteric level. Internal or external fixation and casting, when used as part of the osteotomy, are included. The service is generally performed in an operating room, often for a femoral deformity or malalignment requiring correction at one of these levels.

Select the code based on the osteotomy’s documented location and operative work, rather than the diagnosis alone. The operative report should identify the level and purpose of the bone cut and describe the correction and fixation or cast used. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 27165 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

27165 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,141.24
Alaska*Unavailable$1,556.53
ArizonaUnavailable$1,225.09
ArkansasUnavailable$1,126.73
AtlantaUnavailable$1,297.13
AustinUnavailable$1,271.42
BakersfieldUnavailable$1,261.11
Baltimore/Surr. CntysUnavailable$1,336.90
BeaumontUnavailable$1,208.32
BrazoriaUnavailable$1,229.77

27165 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
27165 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 27165 rate is calculated

Each of 27165’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 27165

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 19.78Practice expense 13.72Malpractice 4.21

37.7100 adjusted RVUs×$33.4009 conversion factor=$1,259.55

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 27165

27165 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 27165

Femoral osteotomy

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.69/0.21Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 27165

Femoral osteotomy

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

27165 without 50 · national facility

$1,259.55

Femoral osteotomy

27165-50 · Bilateral: 150%

$1,889.33

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

27165 compared with similar codes

Compare codes

27165 vs 27161 vs 27178 vs 27146: national Medicare rates

Swap in your local Medicare rate.

  • 27165
    Femoral osteotomy · 19.78 wRVU
    —
  • 27161
    Femoral osteotomy · 17.44 wRVU
    —
  • 27178
    SCFE surgery · 12.6 wRVU
    —
  • 27146
    Hip osteotomy · 18.45 wRVU
    —

How to choose

27161Femoral osteotomy
Choose based on the level of the femoral osteotomy: neck for 27161, versus intertrochanteric or subtrochanteric for 27165.
27178SCFE surgery
27178 describes open treatment of slipped upper femoral epiphysis with an osteotomy. Use 27165 for the intertrochanteric or subtrochanteric osteotomy when the specific slipped-epiphysis service is not being performed.
27146Hip osteotomy
27146 is an osteotomy of the pelvis; 27165 is for a corrective osteotomy of the proximal femur.

Codes related to 27165

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 27165
CodeHow it relatesNational office range
Same family
27161Femoral osteotomyOsteotomy at the femoral neck rather than the intertrochanteric or subtrochanteric level.No office rate
Used instead
27170Femur repairUsed for repair of femoral nonunion or malunion rather than a corrective proximal osteotomy.No office rate
27178SCFE surgerySpecific to open treatment of slipped upper femoral epiphysis with osteotomy.No office rate

27165 billing questions

How does this differ from code 27161?

The osteotomy level distinguishes them: 27165 is for the intertrochanteric or subtrochanteric femur, while 27161 applies to the femoral neck.

Are fixation and casting separately reported?

Fixation or casting used as part of this osteotomy is included in the service. The operative report should describe the method used.

What documentation supports code 27165?

Document the osteotomy’s intertrochanteric or subtrochanteric location, the reason for correcting alignment, and the bone work and fixation or casting performed.

How is bilateral surgery reported?

For bilateral procedures, report modifier 50; CMS pays the bilateral service at 150%.

Can an assistant or co-surgeon be reported?

An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 27165PPRRVU2026_Oct_nonQPP.csv, line 2,772 (RVU26D)

Open CMS sourceHow we calculate rates

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