Open tenotomy with surgical division of the iliotibial band and surrounding fascia of the thigh

Verified May 8, 2026 · 6 sources ↓

Medicare: $464.27
Work RVU: 6.03
Global, days: 90
Region: Knee

Drawn from CMSAAPCFastrvuMdclarityAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative note must name the specific structure(s) released — iliotibial band, fascia lata, or both — not just 'thigh release'
Document the clinical indication: contracture, deformity type, spasticity, or prior failed conservative treatment
Record the surgical approach (e.g., direct lateral longitudinal incision) and extent of the fascial release
Note laterality explicitly in both the preoperative diagnosis and the body of the operative report
Include intraoperative findings confirming the pathology that required open tenotomy rather than a less invasive approach
Post-op plan and any drain placement should be documented to support medical necessity and global period management

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 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27305 describes an open tenotomy of the iliotibial band — a surgical incision through the IT band and associated thigh fascia to relieve tension or correct deformity. The procedure is performed under general or regional anesthesia through a direct lateral approach to the thigh. It is most commonly indicated for IT band contracture causing hip abduction deformity, knee malalignment, or as a component of managing spastic or post-traumatic conditions.

This is a 090-day global procedure, meaning the pre-op visit the day before surgery and all routine post-operative care through day 90 are bundled into the single allowable. Any evaluation for a new or unrelated problem during that window requires modifier 24 (E/M) or modifier 25 (same-day E/M). A return to the OR for a related complication within the global period — hematoma evacuation, wound dehiscence — bills with modifier 78.

The code falls under the femur (thigh region) and knee joint incision subsection. Orthopedic surgery is the dominant billing specialty. Site of service matters: HOPD and ASC payments differ substantially, so confirm your facility contract before quoting patients an out-of-pocket estimate.

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 (6.03) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (13.9) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	6.03
Practice expense RVU	6.62
Malpractice RVU	1.25
Total RVU	13.9
Medicare national rate	$464.27
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	$464.27
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 27305 get rejected.

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

Missing laterality — claim submitted without LT or RT modifier triggers automatic payer edit on unilateral procedures
Medical necessity not established — no documentation of failed conservative care (physical therapy, stretching, bracing) prior to surgery
Bundling conflict when billed same-day with other thigh or knee incision codes without a supporting modifier 59 or XS
Operative note uses generic language ('soft tissue release') without explicitly naming the iliotibial band, failing specificity requirements
Global period violation — post-op E/M billed within 90 days without modifier 24 to indicate an unrelated condition

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Does 27305 carry a global period, and what's included?

Yes — 90-day global. The day-before pre-op visit, the procedure itself, and all routine post-op care through day 90 are bundled. Bill modifier 24 for any unrelated E/M and modifier 78 for an unplanned return to the OR for a related complication within that window.

02Should I append LT or RT to 27305?

Yes. 27305 is a unilateral procedure. Always append LT or RT. If both IT bands are released in the same session, bill with modifier 50 or submit bilateral line items with LT and RT — confirm your payer's preferred bilateral format before submitting.

03Can 27305 be billed the same day as a knee arthroscopy?

It can, but expect an NCCI bundling edit. If the open IT band release is a distinct procedure not integral to the arthroscopy, append modifier 59 or XS with supporting documentation showing separate anatomic sites and separate indications. Check current NCCI edits before assuming the combination passes clean.

04What's the difference between 27305 and a percutaneous IT band release?

27305 is an open tenotomy. There is no AMA CPT code specific to percutaneous IT band release — some payers accept an unlisted code (27599) for that approach, but coverage and payment vary by payer. Use 27305 only when the operative report confirms an open incision.

05What documentation is most likely to get 27305 denied on audit?

Audit teams flag operative notes that name the incision site generically without identifying the iliotibial band or fascia lata specifically, and records with no pre-operative documentation of failed conservative treatment. Both gaps are addressable at the time of dictation.

06Is 27305 typically performed in an ASC or HOPD setting?

Both settings are used. ASC and HOPD facility payments differ — see the site of service comparison on this page. The physician's professional fee is the same regardless of setting, but your facility contract and patient cost-sharing implications differ materially.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the structure released (iliotibial band, fascia lata, or combined), the surgical approach, laterality, and intraoperative findings from the surgeon's dictation. It flags operative notes that use generic terms like 'soft tissue release' without naming the IT band — the documentation gap most likely to trigger a medical necessity denial or audit query on 27305.

See how Mira captures CPT 27305 documentation