A HSR is simply one type of THR. There is no separate CPT code for HSR. When we bill insurance companies for the procedure we use CPT code #27130 which is defined as replacing both surfaces of the hip joint. The cost to the insurance company when I perform HSR is the same as for traditional stemmed THR. The implants I use are FDA approved Biomet Recap Femoral and Biomet Magnum Acetabular Components. Using them in combination as a total metal on metal hip surface replacement in the United States constitutes an off-label use. This is perfectly legal and is a commonly accepted practice in the United States. The only restriction that the FDA can legally enforce is a ban on the promotion of these implants as total resurfacing combinations in the United States. These implants are allowed to be promoted as total resurfacing devices throughout the remainder of the world. Off-label use implants and medicines in the United States is a right conferred on licensed physicians in the United States. To date , we have had no retrospective denial of payment for HSR; however , we cannot guarantee the action of your insurance company. The ultimate responsibility to pay for services is yours.