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Billing code 27181: Femoral osteotomyMedicare rate & RVUs

Reports a femoral neck osteotomy to correct deformity associated with slipped capital femoral epiphysis, rather than traction or pinning in situ.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,032.42 for 27181 nationally in a facility.

Medicare rate · 27181

Femoral osteotomy

Swap in your local Medicare rate.

Work RVUs
15.78
Total RVUs
30.91
Global days
090

National rate · 2026

$1,032.42

Facility setting, before claim adjustments.

See every locality for 27181 → · 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 27181 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 27181 covers

This procedure surgically cuts the femoral neck to correct alignment in a patient with slipped capital femoral epiphysis. Orthopedic surgeons typically perform it in an operating room when the deformity calls for osteotomy rather than treatment by traction or pinning in situ. The operative report should identify the affected side, femoral neck osteotomy, the deformity being corrected, and the correction performed.

Report the code for the femoral neck osteotomy, not simply because the patient has a slipped epiphysis; documentation should support the procedure actually performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeons and team surgery are 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 27181 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

27181 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$934.68
Alaska*Unavailable$1,271.29
ArizonaUnavailable$1,004.11
ArkansasUnavailable$922.68
AtlantaUnavailable$1,062.79
AustinUnavailable$1,043.54
BakersfieldUnavailable$1,036.46
Baltimore/Surr. CntysUnavailable$1,096.10
BeaumontUnavailable$989.07
BrazoriaUnavailable$1,008.48

27181 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.

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View every state and territory as a table
27181 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 27181 rate is calculated

Each of 27181’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 · 27181

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 15.78Practice expense 11.78Malpractice 3.35

30.9100 adjusted RVUs×$33.4009 conversion factor=$1,032.42

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

Payment rules and modifiers for 27181

27181 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 27181

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)0Not permitted.
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 · 27181

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

27181 without 50 · national facility

$1,032.42

Femoral osteotomy

27181-50 · Bilateral: 150%

$1,548.63

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

27181 compared with similar codes

Compare codes

27181 vs 27176 vs 27175 vs 27177: national Medicare rates

Swap in your local Medicare rate.

  • 27181
    Femoral osteotomy · 15.78 wRVU
    —
  • 27176
    Slipped epiphysis treatment · 12.6 wRVU
    —
  • 27175
    Slipped epiphysis treatment · 9.15 wRVU
    —
  • 27177
    Slipped epiphysis · 15.69 wRVU
    —

How to choose

27176Slipped epiphysis treatment
27176 describes pinning the epiphysis in situ. Use 27181 when the documented procedure is a femoral neck osteotomy to correct alignment.
27175Slipped epiphysis treatment
27175 describes treatment by traction without reduction. It does not describe a femoral neck osteotomy.
27177Slipped epiphysis
Both codes are in the slipped-epiphysis treatment family. Select 27181 when the operative documentation supports a femoral neck osteotomy; use 27177 for its specified osteotomy-based treatment.

Codes related to 27181

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

Codes related to 27181
CodeHow it relatesNational office range
Same family
27175Slipped epiphysis treatmentSlipped-epiphysis treatment by traction without reduction.No office rate
27176Slipped epiphysis treatmentSlipped-epiphysis treatment by pinning in situ.No office rate
27177Slipped epiphysisA separate osteotomy-based treatment option for slipped femoral epiphysis.No office rate
27178SCFE surgeryAnother treatment code in the slipped femoral epiphysis series.No office rate

27181 billing questions

How does this differ from pinning in situ?

Use 27181 when the surgeon performs a femoral neck osteotomy to correct alignment. Code 27176 describes treatment by pinning in situ, rather than osteotomy.

Is 27181 the code for every slipped epiphysis?

No. The operative method determines the code. This code describes femoral neck osteotomy, not treatment by traction or pinning in situ.

What documentation supports 27181?

The operative report should document the femoral neck osteotomy, the side treated, the slipped-epiphysis deformity, and the correction performed.

How is bilateral surgery reported?

CMS identifies this as a bilateral procedure. When reported with modifier 50, payment is at 150%.

Can an assistant or co-surgeon be reported?

An assistant at surgery may be paid. CMS does not permit co-surgeons or team surgery for this code.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

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 27181PPRRVU2026_Oct_nonQPP.csv, line 2,779 (RVU26D)

Open CMS sourceHow we calculate rates

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