Secondary reconstruction of the infrapatellar (patellar) tendon using a fascial or tendon graft — includes harvesting the graft as part of the procedure.

Verified May 8, 2026 · 6 sources ↓

Medicare: $775.23
Total RVUs: 23.21
Global, days: 90
Region: Knee

Drawn from CMSAAPCSynthasomePayerprice

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify that this is a secondary reconstruction, not a primary suture repair — the operative note must distinguish the procedure from 27380
Identify the graft type used (autograft fascia lata, semitendinosus allograft, synthetic augmentation, etc.) and confirm graft harvest is documented
Document the surgical approach and extent of tendon defect requiring grafting
Record whether a separate incision was used for graft harvest — if so, a separate graft code may apply
Note any concurrent procedures performed (e.g., arthroscopy, tendon transfer) with distinct documentation to support separate billing if applicable
Include pre-operative diagnosis confirming chronic rupture, failed primary repair, or degenerative defect requiring reconstruction

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 58 Staged or related 59 Distinct service 76 Repeat, same physician 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 ↓

27381 is the go-to code when a patellar tendon repair requires augmentation or reconstruction with a fascial or tendon graft, distinguishing it from 27380, which covers primary suture repair only. The graft harvest is bundled into 27381 — don't add a separate graft code unless the donor site is non-adjacent and accessed through a separate incision (e.g., 20902 for a major bone graft from a distant site). The 'secondary' designation refers to the reconstructive complexity of the procedure, not necessarily a reoperation, though failed primary repairs presenting for revision also fall here.

The code sits in the femur and knee joint repair/reconstruction section. Don't confuse it with 27385/27386, which address quadriceps or hamstring rupture, or with 27437, which is a patellar arthroplasty (bone/joint work, not tendon). If a tendon transfer is also performed during the same session, 27396 may be separately reportable — confirm NCCI edits and document the distinct service clearly.

The 90-day global period means routine post-op visits, dressing changes, and suture removal are bundled through day 90. Any unrelated service in that window needs modifier 24 or 25 on the E/M. A return to the OR for a related complication (e.g., re-rupture, wound dehiscence affecting the repair) bills under modifier 78; an unrelated procedure in the global uses modifier 79.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.49
Practice expense RVU	10.53
Malpractice RVU	2.19
Total RVU	23.21
Medicare national rate	$775.23
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	$775.23
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 27381 get rejected.

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

Billing 27381 when operative note describes primary suture only — payers default to 27380 without graft documentation
Unbundling a separate graft harvest code when the donor site was not accessed through a distinct, separate incision
Missing laterality modifier (LT/RT) causing claim rejection or delayed processing under many payer edits
Using 27381 and 27380 together on the same knee without modifier 59/XS and clear documentation of distinct repair sites
Post-op E/M visits billed without modifier 24 during the 90-day global, triggering automatic bundling denials

Frequently asked questions

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

01What separates 27381 from 27380?

27380 is a primary suture repair — no graft. 27381 is a secondary reconstruction that includes obtaining and using a fascial or tendon graft. If your operative note doesn't document a graft, you're billing 27380, not 27381.

02Is the graft harvest separately billable with 27381?

No, unless the donor site is non-adjacent and accessed through a completely separate incision. When the graft is harvested as part of the same operative field, it's bundled into 27381. A distant-site harvest like iliac crest bone graft via separate incision could support an add-on graft code such as 20902.

03Can 27381 and 27380 be billed together on the same operative session?

Only if distinct anatomic sites on the same knee are repaired with different techniques — one primary suture, one with graft augmentation. You'll need modifier 59 or XS and airtight documentation. Same-site billing of both will trigger NCCI bundling edits.

04What modifier do I use if the patient re-ruptures during the 90-day global and returns to the OR?

Use modifier 78 — unplanned return to the OR for a procedure related to the original surgery during the global period. Modifier 79 is for an unrelated procedure. Inverting these is a common audit finding.

05Does 'secondary reconstruction' mean the patient had a previous repair?

Not necessarily. The terminology refers to the reconstructive nature of the procedure — a graft-augmented repair — rather than strictly indicating a reoperation. That said, failed prior repairs requiring revision also bill under 27381. Document the clinical context clearly either way.

06Can I bill an arthroscopy separately with 27381 if diagnostic scope was performed at the same session?

Only if the arthroscopy was a distinct, separately documented procedure with its own indication. Diagnostic arthroscopy performed solely to guide the open reconstruction is typically bundled. Check NCCI edits for the specific arthroscopy code pairing and use modifier 59/XS with robust documentation if billing separately.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures graft type and source, the distinction between primary versus secondary/reconstructive repair, approach description, and whether a separate incision was used for harvest — the exact details that separate 27381 from 27380 at audit. This prevents downcoding to the primary repair code and blocks improper unbundling flags on graft harvest line items.

See how Mira captures CPT 27381 documentation