No office rate
Both describe thigh-level amputation, but 27591 specifies primary closure. Choose 27590 when that closure distinction is not documented.
On this page
CMS RVU26D · Effective 2026-10-01
27591 Thigh amputation Medicare reimbursement rates in California
Reports a through-femur thigh amputation closed primarily, typically for severe limb ischemia, infection, trauma, or disease requiring removal of the limb. Compare 27591 office and facility rates across CMS payment localities in California.
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 27591 in California?
California has 29 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 29 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$884.20–$1043.37
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $159.17 per service.
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 27591 pays more and less in California
Amputation surgery
About 27591: Thigh amputation with primary closure
Reports a through-femur thigh amputation closed primarily, typically for severe limb ischemia, infection, trauma, or disease requiring removal of the limb.
This service removes the lower limb through the femur and includes primary closure of the operative site. It may be performed by an orthopedic, vascular, or general surgeon, often in a hospital operating room for conditions such as advanced limb ischemia with gangrene, an unsalvageable traumatic injury, or extensive infection. The amputation level is through the thigh; a below-knee procedure is a different service.
Select this code when the operative documentation supports a thigh amputation with primary closure. The note should identify the level and side, the reason for amputation, and how the wound was managed. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery services may be paid; co-surgeons are paid only with supporting documentation, and team surgery is not permitted.
CMS billing rules for 27591
- 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 RVU13.59 · 51%
- Practice expense (office) RVU10.12 · 38%
- Malpractice RVU2.91 · 11%
15
Medicare services in 2024 · #6065 by national volume
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.
27591 compared with similar codes
Office rates for California, from the same CMS release.
No office rate
Choose 27592 when immediate prosthesis fitting is part of the service; primary closure without that distinction points to 27591.
No office rate
27594 describes revision of an existing thigh amputation. Code 27591 is for the amputation itself with primary closure.
No office rate
27880 is an amputation through the tibia and fibula. Code 27591 is for an amputation through the femur.
Compare 27591 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.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield | Office Unavailable | Facility $892.20 |
| Chico | Office Unavailable | Facility $884.20 |
| El Centro | Office Unavailable | Facility $884.68 |
| Fresno | Office Unavailable | Facility $884.20 |
| Hanford-Corcoran | Office Unavailable | Facility $884.20 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $936.94 |
| Madera | Office Unavailable | Facility $884.20 |
| Merced | Office Unavailable | Facility $884.20 |
| Modesto | Office Unavailable | Facility $884.20 |
| Napa | Office Unavailable | Facility $977.40 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $926.72 |
| Redding | Office Unavailable | Facility $884.20 |
| Rest Of California | Office Unavailable | Facility $884.20 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $915.46 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $915.47 |
| Salinas | Office Unavailable | Facility $911.85 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $924.48 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $1018.26 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $1014.95 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $1043.37 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $1029.86 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $898.73 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $926.24 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $912.85 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $934.72 |
| Stockton | Office Unavailable | Facility $884.20 |
| Vallejo | Office Unavailable | Facility $972.63 |
| Visalia | Office Unavailable | Facility $884.20 |
| Yuba City | Office Unavailable | Facility $884.20 |
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27591 billing questions
How does this differ from 27590?
Use 27591 when the thigh amputation is closed primarily. Code 27590 describes a thigh amputation without that primary-closure distinction.
When would 27592 be selected instead?
27592 is the sibling code for a thigh amputation with immediate prosthesis fitting. Primary closure alone supports 27591, not 27592.
Is primary closure separately reported?
Primary closure is the distinguishing feature of 27591 and is included in this service; it is not a separate amputation code.
How is bilateral reporting handled?
For bilateral thigh amputations in the same session, report modifier 50; CMS pays the bilateral procedure at 150%.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is provided.
What documentation supports this code?
Document the amputation level through the femur, laterality, clinical reason, and primary closure of the operative site.
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.
2,95327570,,Fixation of knee joint,A,,1.75,2.37,NA,2.37,,0.37,4.49,4.49,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,95427580,,Fusion of knee,A,,20.57,15.63,NA,15.63,,4.36,40.56,40.56,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,95527590,,Amputate leg at thigh,A,,13.13,5.19,NA,5.19,,3.27,21.59,21.59,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,95627591,,Amputate leg at thigh,A,,13.59,10.12,NA,10.12,,2.91,26.62,26.62,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,95727592,,Amputate leg at thigh,A,,10.71,5.49,NA,5.49,,2.61,18.81,18.81,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,95827594,,Amputation follow-up surgery,A,,7.11,5.53,NA,5.53,,1.67,14.31,14.31,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,95927596,,Amputation follow-up surgery,A,,11.01,6.11,NA,6.11,,2.64,19.76,19.76,0,090,0.10,0.69,0.21,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00