Release or recession of the proximal hamstring tendon at the hip, performed open.

Verified May 8, 2026 · 5 sources ↓

Medicare: $643.97
Work RVU: 9.04
Global, days: 90
Region: Hip

Drawn from CMSPalmetto GBAEmedny

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 5 cited references ↓

Diagnosis driving the procedure — specify neuromuscular condition, spasticity etiology, or contracture with supporting clinical findings
Laterality documented explicitly (left, right, or bilateral) in both the pre-op assessment and operative note
Operative note identifies the specific tendon(s) released or recessed and the surgical approach by name — do not use generic language like 'standard approach'
Pre-operative conservative management attempted and failed — physical therapy trials, medications, or prior injections should be documented
Functional deficit or gait abnormality quantified in pre-op notes to justify medical necessity
If bilateral, documentation must explicitly state both sides were addressed in the same operative session

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 27097 describes an open release or recession of the proximal hamstring tendon — typically performed to address spasticity, contracture, or functional deformity affecting hip extension and knee flexion. The procedure is most commonly performed in patients with neuromuscular conditions such as cerebral palsy, spinal cord injury sequelae, or other upper motor neuron disorders causing hamstring spasticity that has failed conservative management.

The 90-day global period means the surgeon's pre-op visit (day before), the procedure itself, and all routine post-op care through day 90 are bundled into a single payment. Unrelated E/M visits within that window require modifier 24; a separately identifiable E/M on the day of surgery needs modifier 25 appended to the E/M, not the procedure.

If the procedure is performed bilaterally in the same operative session, bill one unit with modifier 50 on a single claim line — Medicare pays 150% of the fee schedule amount (100% for the primary side, 50% for the second). ASC facilities should instead report on two separate claim lines using modifiers LT and RT. Confirm the bilateral surgery indicator in the CMS Physician Fee Schedule lookup before billing, as it governs which reporting method applies.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (9.04) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (19.28) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	9.04
Practice expense RVU	8.32
Malpractice RVU	1.92
Total RVU	19.28
Medicare national rate	$643.97
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$643.97
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 27097 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Medical necessity not established — no documented failure of conservative management prior to surgery
Laterality missing or ambiguous in operative note, triggering claim-level edit or payer audit
Bilateral procedure billed with two units instead of one unit with modifier 50 on the professional claim
Unrelated E/M billed within the 90-day global period without modifier 24, causing automatic bundling denial
Diagnosis code does not support the procedure — mismatch between ICD-10 etiology and hamstring release indication

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What is the global period for CPT 27097?

90 days. All routine post-op visits, wound checks, and stitch removals from the day before surgery through day 90 are bundled. Bill unrelated services with modifier 24; a separate E/M on the day of surgery needs modifier 25.

02How do I bill CPT 27097 when performed bilaterally?

On professional claims, bill one unit of service with modifier 50 on a single claim line. Medicare allows 150% of the fee schedule amount. ASC facility claims should use two separate claim lines with modifiers LT and RT instead of modifier 50.

03Can CPT 27097 be billed in an ASC setting?

Yes. The ASC facility payment rate differs from the HOPD rate — see the site of service comparison on this page. ASCs report bilateral procedures on two lines with LT and RT rather than modifier 50.

04Which diagnoses most commonly support CPT 27097?

Spastic hemiplegia or diplegia (cerebral palsy), spasticity from spinal cord injury, and fixed hamstring contracture with documented functional deficit are the primary supporting diagnoses. The ICD-10 must match the documented etiology in the clinical note.

05What modifier is needed if the surgeon returns to the OR within 90 days to address a complication related to the original hamstring release?

Use modifier 78 — unplanned return to the OR for a procedure related to the original surgery during the global period. Modifier 79 is for unrelated procedures in the global window. Do not invert these.

06Does modifier 22 apply to CPT 27097?

It can, when the procedure involves substantially increased complexity — for example, severe scarring from prior surgery or marked obesity significantly prolonging operative time. Document the specific factors and increased time in the operative note; without that, modifier 22 claims are routinely denied.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures laterality, the specific tendon targeted, the surgical approach, the underlying neuromuscular diagnosis, and documentation of prior conservative treatment failures directly from dictation. This prevents the two most common denial triggers for 27097: missing laterality on the claim and absent medical necessity narrative — both of which draw payer audit flags on 90-day global period cases.

See how Mira captures CPT 27097 documentation