No office rate
Choose 27458 for the femoral osteotomy with insertion of an internal lengthening device. Code 27466 represents femoral lengthening by a different approach.
On this page
CMS RVU26D · Effective 2026-10-01
27458 Femoral lengthening Medicare reimbursement rates
Report this femoral osteotomy when the surgeon inserts an internal device intended to lengthen the femur, such as to address a limb-length discrepancy. Compare 27458 office and facility rates across CMS payment localities.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 27458?
The service location and office or facility setting determine which base rate applies. These are the supported base rates for the 109 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 27458 pays more and less
Orthopedic surgery
About 27458: Femoral osteotomy with internal lengthening device
Report this femoral osteotomy when the surgeon inserts an internal device intended to lengthen the femur, such as to address a limb-length discrepancy.
An orthopedic surgeon performs an osteotomy of the femur and places an internal lengthening device so the bone can be lengthened gradually. The procedure may be considered for a clinically significant limb-length discrepancy or femoral shortening, including problems related to growth or prior injury. It is a major operative service generally performed in a hospital or ambulatory surgery center.
Choose this code when the operative service includes both the femoral osteotomy and insertion of the internal lengthening device; a plan to lengthen the bone alone is not enough. The operative report should identify the femur, describe the osteotomy, and document device placement and the indication. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure claim, 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-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 27458
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU26.65 · 51%
- Practice expense (office) RVU20.06 · 39%
- Malpractice RVU5.13 · 10%
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.
27458 compared with similar codes
Office rate ranges across all CMS payment localities, from the same CMS release.
No office rate
Code 27465 concerns shortening the femur. Code 27458 is for an osteotomy with an internal device intended to lengthen it.
No office rate
Code 27454 is used for femoral realignment. Use 27458 when the operative plan includes internal-device lengthening rather than realignment alone.
See how rates vary across the country
27458 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Compare 27458 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | Office Unavailable | Facility $1573.39 |
| Alaska* | Office Unavailable | Facility $2143.19 |
| Arizona | Office Unavailable | Facility $1686.06 |
| Arkansas | Office Unavailable | Facility $1553.93 |
| Atlanta | Office Unavailable | Facility $1779.33 |
| Austin | Office Unavailable | Facility $1752.61 |
| Bakersfield | Office Unavailable | Facility $1745.74 |
| Baltimore/Surr. Cntys | Office Unavailable | Facility $1835.27 |
| Beaumont | Office Unavailable | Facility $1659.04 |
| Brazoria | Office Unavailable | Facility $1694.90 |
| Chicago | Office Unavailable | Facility $1962.98 |
| Chico | Office Unavailable | Facility $1731.45 |
| Colorado | Office Unavailable | Facility $1747.54 |
| Connecticut | Office Unavailable | Facility $1836.88 |
| Dallas | Office Unavailable | Facility $1712.50 |
| Dc + Md/Va Suburbs | Office Unavailable | Facility $1918.20 |
| Delaware | Office Unavailable | Facility $1710.61 |
| Detroit | Office Unavailable | Facility $1825.60 |
| East St. Louis | Office Unavailable | Facility $1851.65 |
| El Centro | Office Unavailable | Facility $1732.31 |
| Fort Lauderdale | Office Unavailable | Facility $1878.66 |
| Fort Worth | Office Unavailable | Facility $1708.03 |
| Fresno | Office Unavailable | Facility $1731.45 |
| Galveston | Office Unavailable | Facility $1704.46 |
| Hanford-Corcoran | Office Unavailable | Facility $1731.45 |
| Hawaii, Guam | Office Unavailable | Facility $1751.16 |
| Houston | Office Unavailable | Facility $1798.36 |
| Idaho | Office Unavailable | Facility $1587.60 |
| Indiana | Office Unavailable | Facility $1594.52 |
| Iowa | Office Unavailable | Facility $1571.23 |
| Kansas | Office Unavailable | Facility $1582.19 |
| Kentucky | Office Unavailable | Facility $1642.57 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $1833.04 |
| Madera | Office Unavailable | Facility $1731.45 |
| Manhattan | Office Unavailable | Facility $1997.42 |
| Merced | Office Unavailable | Facility $1731.45 |
| Metropolitan Boston | Office Unavailable | Facility $1879.13 |
| Metropolitan Kansas City | Office Unavailable | Facility $1686.69 |
| Metropolitan Philadelphia | Office Unavailable | Facility $1808.07 |
| Metropolitan St. Louis | Office Unavailable | Facility $1699.68 |
| Miami | Office Unavailable | Facility $2020.96 |
| Minnesota | Office Unavailable | Facility $1630.31 |
| Mississippi | Office Unavailable | Facility $1593.65 |
| Modesto | Office Unavailable | Facility $1731.45 |
| Montana** | Office Unavailable | Facility $1731.16 |
| Napa | Office Unavailable | Facility $1916.35 |
| Nebraska | Office Unavailable | Facility $1573.33 |
| Nevada** | Office Unavailable | Facility $1703.56 |
| New Hampshire | Office Unavailable | Facility $1737.56 |
| New Mexico | Office Unavailable | Facility $1710.33 |
| New Orleans | Office Unavailable | Facility $1715.27 |
| North Carolina | Office Unavailable | Facility $1624.76 |
| North Dakota** | Office Unavailable | Facility $1629.72 |
| Northern Nj | Office Unavailable | Facility $1906.44 |
| Nyc Suburbs/Long Island | Office Unavailable | Facility $2061.95 |
| Ohio | Office Unavailable | Facility $1674.58 |
| Oklahoma | Office Unavailable | Facility $1621.60 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $1813.77 |
| Portland | Office Unavailable | Facility $1776.25 |
| Poughkpsie/N Nyc Suburbs | Office Unavailable | Facility $1871.19 |
| Puerto Rico | Office Unavailable | Facility $1736.30 |
| Queens | Office Unavailable | Facility $1986.15 |
| Redding | Office Unavailable | Facility $1731.45 |
| Rest Of California | Office Unavailable | Facility $1731.45 |
| Rest Of Florida | Office Unavailable | Facility $1788.21 |
| Rest Of Georgia | Office Unavailable | Facility $1692.04 |
| Rest Of Illinois | Office Unavailable | Facility $1769.68 |
| Rest Of Louisiana | Office Unavailable | Facility $1647.25 |
| Rest Of Maine | Office Unavailable | Facility $1613.13 |
| Rest Of Maryland | Office Unavailable | Facility $1734.39 |
| Rest Of Massachusetts | Office Unavailable | Facility $1746.47 |
| Rest Of Michigan | Office Unavailable | Facility $1695.31 |
| Rest Of Missouri | Office Unavailable | Facility $1634.58 |
| Rest Of New Jersey | Office Unavailable | Facility $1845.37 |
| Rest Of New York | Office Unavailable | Facility $1647.11 |
| Rest Of Oregon | Office Unavailable | Facility $1677.93 |
| Rest Of Pennsylvania | Office Unavailable | Facility $1667.14 |
| Rest Of Texas | Office Unavailable | Facility $1680.71 |
| Rest Of Washington | Office Unavailable | Facility $1737.63 |
| Rhode Island | Office Unavailable | Facility $1752.02 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $1786.66 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $1793.26 |
| Salinas | Office Unavailable | Facility $1786.13 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $1811.05 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $1998.08 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $1992.25 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $2046.06 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $2022.25 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $1760.26 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $1814.75 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $1788.15 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $1831.47 |
| Seattle (King Cnty) | Office Unavailable | Facility $1896.75 |
| South Carolina | Office Unavailable | Facility $1654.88 |
| South Dakota** | Office Unavailable | Facility $1617.73 |
| Southern Maine | Office Unavailable | Facility $1662.25 |
| Stockton | Office Unavailable | Facility $1731.45 |
| Suburban Chicago | Office Unavailable | Facility $1888.10 |
| Tennessee | Office Unavailable | Facility $1591.20 |
| Utah | Office Unavailable | Facility $1673.82 |
| Vallejo | Office Unavailable | Facility $1907.95 |
| Vermont | Office Unavailable | Facility $1640.16 |
| Virgin Islands | Office Unavailable | Facility $1736.30 |
| Virginia | Office Unavailable | Facility $1669.74 |
| Visalia | Office Unavailable | Facility $1731.45 |
| West Virginia | Office Unavailable | Facility $1717.58 |
| Wisconsin | Office Unavailable | Facility $1584.79 |
| Wyoming** | Office Unavailable | Facility $1686.95 |
| Yuba City | Office Unavailable | Facility $1731.45 |
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27458 billing questions
How does this differ from femoral lengthening code 27466?
Use 27458 when the operation includes a femoral osteotomy and insertion of an internal lengthening device. Code 27466 is the alternative for femoral lengthening performed without that specified internal-device approach.
What documentation supports reporting 27458?
The operative report should establish the femoral osteotomy, internal lengthening device insertion, treated side, and the clinical reason for lengthening, such as limb-length discrepancy.
Does the 90-day global period include postoperative care?
Yes. Medicare includes the day-before preoperative visit and 90 days of related postoperative care in this major-surgery global period.
How is bilateral surgery reported under the CMS rule?
For bilateral performance, report modifier 50; CMS pays the bilateral procedure at 150%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation, while 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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
2,90227454,,Realignment of thigh bone,A,,18.69,12.70,NA,12.70,,3.98,35.37,35.37,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,90327455,,Realignment of knee,A,,13.03,10.93,NA,10.93,,2.77,26.73,26.73,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,90427457,,Realignment of knee,A,,13.68,9.76,NA,9.76,,2.91,26.35,26.35,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,90527458,,Osteot femur imed lngth dev,A,,26.65,20.06,NA,20.06,,5.13,51.84,51.84,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,90627465,,Shortening of thigh bone,A,,20.60,13.74,NA,13.74,,4.39,38.73,38.73,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,90727466,,Lengthening of thigh bone,A,,22.08,14.21,NA,14.21,,4.71,41.00,41.00,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,90827470,,Repair of thigh,A,,16.71,12.23,NA,12.23,,3.55,32.49,32.49,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00