CPT Code 27299: Unlisted Procedures on the Pelvis or Hip Joint

What is an unlisted pelvis or hip joint procedure?

CPT code 27299 is a code used when a specific code does not exist for a procedure performed on the pelvis or hip joint. As defined by the Current Procedural Terminology (CPT) manual, this code serves as a placeholder when no other CPT code accurately describes the service provided.

Healthcare providers may use CPT 27299 for procedures involving the hip or pelvic region, such as specialized interventions not covered by existing codes for hip arthroplasty, gluteus medius repair, or procedures involving imaging guidance, to ensure proper coding and accurate billing. Thorough and detailed documentation is essential to support medical necessity and to help the insurance company determine appropriate reimbursement.

CPT code 27299 does not have assigned relative value units (RVUs) or a defined global period, so reimbursement and coverage vary depending on payer policies. Providers must compare the service with a specific procedure and submit supporting materials for insurance review to ensure proper reimbursement.

Documentation requirements

When using CPT 27299, thorough and accurate documentation is critical to support medical necessity and facilitate appropriate reimbursement. Since this is an unlisted procedure code, the provider must clearly explain why no specific code exists for the procedure performed. Submit the following:

• Full operative report detailing the step-by-step description of the hip joint procedure or pelvis intervention
• Diagnosis and indication for the service, including the anatomic site(s) treated
• Explanation of why the CPT manual lacks a specific CPT code to represent the service
• A comparative CPT code (e.g., for total hip arthroplasty or other hip procedures) to aid in reimbursement benchmarking
• Description of any imaging guidance, tools, or devices used during the procedure, pelvis, or hip
• Any other procedures performed during the same session, if separately reportable
• A cover letter providing clinical rationale, references, and justification for use of an unlisted CPT code

Supporting detailed documentation is crucial to help the insurance company determine relative value units, apply a proper global period (if applicable), and ensure proper reimbursement. This also ensures accurate billing and protects the healthcare provider in the event of audits or denials.

Billing guidelines

Here are key billing guidelines to ensure proper reimbursement and coding accuracy when using CPT code 27299 for pelvis or hip joint procedures

• Submit as a manual review item with supporting documentation
• Reimbursement depends on payer acceptance of comparative code
• Cannot be used when a Category I or III CPT code is available
• Requires prior authorization in nearly all cases

Payers may require peer-reviewed evidence for coverage.

Other relevant CPT codes

• 29914 – Hip arthroscopy with femoroplasty
• 27130 – Total hip arthroplasty
• 27125 – Hemiarthroplasty