Surgical excision of a nerve in the popliteal (posterior knee) region, targeting the gastrocnemius nerve to relieve spasm or chronic pain.

Verified May 8, 2026 · 6 sources ↓

Medicare: $504.35
Work RVU: 6.31
Global, days: 90
Region: Knee

Drawn from CMSFastrvuEmednyAAPCMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specific nerve identified by name (e.g., gastrocnemius nerve branch, popliteal nerve) in the operative report
Surgical approach documented explicitly — not just 'posterior knee incision'
Medical necessity established: failed conservative treatment for nerve-related pain or spasticity
Laterality confirmed in both the operative note and the claim (left vs. right)
Preoperative diagnosis supported by clinical notes, imaging, or nerve conduction studies where applicable

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 59 Distinct service 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27326 covers open neurectomy of the popliteal or gastrocnemius nerve — the surgical resection of nerve tissue behind the knee to relieve intractable pain or muscle spasm. It sits in the excision subsection of femur and knee procedures, adjacent to 27325 (hamstring neurectomy). The 90-day global period means all routine post-op care, dressing changes, and office visits through day 90 are bundled. Bill anything unrelated to the neurectomy in that window with modifier 79; a related unplanned return to the OR gets modifier 78.

Documentation must establish medical necessity clearly — nerve-related pain or spasticity that failed conservative management. Operative notes should identify the specific nerve resected and the surgical approach used. Vague notes referencing 'posterior knee dissection' without naming the nerve are a common audit flag. Confirm laterality in both the note and the claim; payers expect LT or RT on a unilateral procedure.

Site of service matters here: HOPD and ASC payments differ substantially (see the Site of Service comparison table). If this is billed same-day with another knee procedure, modifier 51 applies to the lower-valued code, and modifier 59 or XS defends separate billing if bundling edits fire under NCCI.

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 (6.31) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (15.1) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	6.31
Practice expense RVU	7.46
Malpractice RVU	1.33
Total RVU	15.1
Medicare national rate	$504.35
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	$504.35
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 27326 get rejected.

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

Operative note does not name the specific nerve resected, triggering a medical necessity or unbundling denial
Missing laterality modifier (LT or RT) causes claim rejection or processing hold
Procedure billed without modifier 51 when performed same-day as another knee surgery, rejected as duplicate or improperly bundled
Insufficient documentation of failed conservative management prior to surgical intervention
Claim submitted during global period of a prior knee procedure without modifier 79 or 78 to explain the new service

Frequently asked questions

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

01What nerve does CPT 27326 actually cover?

27326 targets the popliteal or gastrocnemius nerve — the nerve tissue in the posterior knee region. It is not the appropriate code for sural nerve excision; sural nerve neurectomy is coded elsewhere (typically 64784 or 64786 depending on extent). Confirm the nerve in the operative report before selecting this code.

02Do I need modifier LT or RT when billing 27326?

Yes. 27326 is a unilateral procedure. Append LT or RT to specify the operative side. If the neurectomy is performed bilaterally in the same session, use modifier 50 on a single line per most payer instructions, and confirm your specific payer's bilateral billing policy — some require two lines with LT and RT.

03Can 27326 be billed same-day with a knee arthroscopy or other knee procedure?

Yes, but modifier 51 must be applied to the lower-valued procedure, and you may need modifier 59 or XS if NCCI bundling edits fire. Document that the neurectomy was a distinct service from the arthroscopic work, with a separate indication and separate operative description.

04What is the global period for 27326, and what does it include?

27326 carries a 90-day global period. That bundles the day-before pre-op visit, the procedure itself, and all routine post-op care through day 90. An unrelated procedure during that window requires modifier 79. An unplanned return to the OR for a related complication requires modifier 78.

05What ICD-10 diagnoses best support 27326?

Common supporting diagnoses include M79.3- (panniculitis), G57.3- (lesion of medial popliteal nerve), G57.4- (lesion of common peroneal nerve at the knee), and M79.2- (neuralgia and neuritis, unspecified). For spasticity-driven indications, codes from the G80–G83 range may apply. The ICD-10 must match the documented clinical rationale — pain versus spasm versus neurologic deficit.

06How does site of service affect reimbursement for 27326?

HOPD and ASC payments differ significantly — see the Site of Service comparison table on this page. The facility component is paid to the hospital or ASC, not the surgeon. The surgeon's professional fee is the same regardless of site under the PFS, but the total episode cost to the payer shifts. Some payers steer to ASC for cost control.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the specific nerve resected, the surgical approach by name, and the laterality from dictation — then flags the operative note if those elements are missing before the claim drops. That prevents the most common denial pattern for 27326: an operative note that describes the posterior knee exposure in detail but never names the nerve, leaving the coder unable to support medical necessity.

See how Mira captures CPT 27326 documentation