Surgical removal or partial excision of a nerve supplying the hamstring muscle, performed to eliminate painful muscle spasms or neurogenic pain in the posterior thigh.

Verified May 8, 2026 · 7 sources ↓

Medicare: $540.43
Work RVU: 7.02
Global, days: 90
Region: Knee

Drawn from CMSNIHAAPCCgsmedicareEmedny

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Operative note must name the specific nerve branch(es) excised and confirm full or partial removal
Indications documented preoperatively: failed conservative treatment, duration of symptoms, prior interventions
Describe the surgical approach and anatomical exposure used — avoid generic phrases like 'standard approach'
Confirm laterality (left, right, or bilateral) explicitly in both the operative note and procedure order
ICD-10 diagnosis must reflect a neurogenic etiology (e.g., nerve lesion, painful spasm with documented neurological basis)
If modifier 22 is appended, document specific factors increasing operative complexity with estimated additional time

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 XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 27325 describes a neurectomy of the hamstring muscle — surgical interruption or excision of a nerve branch innervating the hamstring to relieve intractable pain or spasm. The procedure falls under Excision Procedures on the Femur (Thigh Region) and Knee Joint in the CPT hierarchy. It carries a 90-day global period, so preoperative care, the operative session, and all routine postoperative management through day 90 are bundled — bill unrelated E/M visits in that window with modifier 24.

This is a low-volume, specialty-specific code with meaningful site-of-service payment differentials: the HOPD rate substantially exceeds the ASC rate (see the Site of Service comparison on this page). When the procedure is performed bilaterally, append modifier 50 on a single claim line. Modifier 22 applies when operative complexity significantly exceeds the typical procedure — document the specific factors (dense adhesions, aberrant anatomy, prior surgery) in the operative note.

Correct ICD-10 diagnosis linkage is critical. Payers expect a diagnosis reflecting neurogenic pain, painful muscle spasm, or a documented nerve lesion at the hamstring. Vague or musculoskeletal-only diagnoses without a neurological component are the most common medical necessity trigger for denial.

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 (7.02) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (16.18) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.02
Practice expense RVU	7.68
Malpractice RVU	1.48
Total RVU	16.18
Medicare national rate	$540.43
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	$540.43
HOPD (APC 5431) Hospital outpatient department	$1,995.02
ASC (PI A2) Ambulatory surgical center (freestanding)	$948.66

Common denial reasons

The recurring reasons claims for CPT 27325 get rejected.

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

Medical necessity denied when diagnosis codes reflect only musculoskeletal pain without documented neurogenic component
Bundling denial when billed same-day with a procedure whose NCCI edit does not allow a modifier bypass
Modifier 24 or 25 omitted for E/M visits billed during the 90-day global period
Laterality mismatch between operative report and claim line when bilateral modifier 50 is used
Modifier 22 appended without supporting documentation of specific complexity factors in the operative note

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Does CPT 27325 have a global period, and what does that include?

27325 carries a 90-day global period. That bundles the surgery, the day-before preoperative visit, and all routine post-op care through day 90. Unrelated E/M visits in that window require modifier 24; a separate significant E/M on the day of surgery requires modifier 25.

02How do you bill 27325 when the neurectomy is performed on both legs?

Append modifier 50 to a single claim line to indicate a bilateral procedure. Per CMS bilateral surgery rules, reimbursement is calculated at 150% of the single-procedure rate. Do not submit two separate line items with LT and RT unless your payer explicitly requires that format — confirm with the specific plan.

03What diagnosis codes support medical necessity for 27325?

Payers expect a diagnosis with a clear neurogenic basis — nerve lesion, neuralgia, or documented painful hamstring spasm attributable to a nerve abnormality. A musculoskeletal pain code alone (e.g., M79.3-) without neurological specificity is a frequent medical necessity denial trigger. Use the most specific ICD-10 available.

04When is modifier 22 appropriate for 27325?

Append modifier 22 only when operative complexity substantially exceeds the typical procedure — documented by specific findings such as dense perineural scarring from prior surgery, aberrant nerve anatomy, or significantly prolonged operative time. The operative note must describe these factors explicitly; modifier 22 without supporting documentation will be stripped on audit.

05Can 27325 be billed the same day as a knee arthroscopy or other thigh procedure?

It depends on whether an NCCI PTP edit exists between 27325 and the other code. Check the CMS NCCI PTP lookup tool for the specific code pair. If a modifier-allowed edit applies, append modifier 59 or an X-modifier with documentation confirming a distinct anatomical site or separate indication. Do not assume same-day billing is always permitted.

06Is 27325 typically performed in an ASC or HOPD, and does it matter for payment?

Both settings are viable, but the payment differential is significant — HOPD pays nearly double the ASC rate for this code. For practices that perform this procedure in multiple settings, site-of-service selection affects net reimbursement meaningfully. See the Site of Service comparison table on this page for current figures.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the nerve branch name, extent of excision (full vs. partial), surgical approach, laterality, and documented indication from dictation — the exact fields auditors check first on a 27325 claim. That prevents the two most common denials: vague operative notes that omit which nerve was excised, and diagnosis-procedure mismatches that trigger medical necessity review.

See how Mira captures CPT 27325 documentation