Primary open suture repair of a ruptured quadriceps or hamstring muscle; acute, first-time repair without graft or secondary reconstruction.

Verified May 8, 2026 · 6 sources ↓

Medicare: $588.52
Total RVUs: 17.62
Global, days: 90
Region: Knee

Drawn from CMSAAPCFindacodeBeckersascEmedny

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm acuity: document that the rupture is acute and this is the primary repair, not a secondary reconstruction.
Name the specific muscle or tendon repaired (quadriceps tendon, proximal hamstring tendon, etc.) — 'thigh muscle repair' alone is insufficient.
Document the surgical approach: incision location, extent of dissection, and repair technique (suture type, configuration).
Record laterality explicitly (right vs. left thigh) to support LT/RT modifier assignment.
If complexity significantly exceeded typical repair — e.g., massive retraction, extensive debridement — document the additional work to support modifier 22.
Confirm no fascial or tendon graft was used; graft use shifts the code to 27386.

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 58 Staged or related 59 Distinct service 76 Repeat, same physician 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 6 cited references ↓

CPT 27385 covers the primary open repair of a ruptured quadriceps or hamstring muscle — the first-time, acute fix. The quadriceps tendon is anatomically part of the quadriceps muscle complex, so open repair of a quadriceps tendon rupture falls here, not under a separate tendon code. Confirm with the operative note whether the rupture is acute: if the surgeon uses fascial or tendon graft, or if the repair is secondary reconstruction of an old rupture, the correct code is 27386 instead.

The 90-day global period covers all routine post-op care through day 90. Separate E/M visits within that window require modifier 24 (unrelated) or 25 (same-day, separate problem). A May 2025 AMA CPT Assistant correction explicitly confirmed that open proximal hamstring tendon repair should be reported with 27385, not unlisted code 27599 — a point that had caused inconsistent billing since a 2015 guidance error.

Site of service matters here. HOPD and ASC payment rates differ substantially (see the site-of-service comparison table). Most cases land in an ASC or outpatient hospital setting. Bilateral thigh repairs on the same date are rare but would require modifier 50.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.76
Practice expense RVU	9.49
Malpractice RVU	1.37
Total RVU	17.62
Medicare national rate	$588.52
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	$588.52
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 27385 get rejected.

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

Code billed as 27385 when operative note describes graft use or secondary reconstruction, which requires 27386.
Unlisted code 27599 substituted for open hamstring repair — a known billing error corrected by the May 2025 AMA CPT Assistant; payers may reject 27599 when 27385 is clearly applicable.
Missing or ambiguous acuity documentation: payer cannot confirm the rupture was acute and the repair was primary.
Laterality modifier absent when payer policy requires LT or RT for unilateral extremity procedures.
Same-day E/M billed without modifier 25, triggering global period bundling denial.

Frequently asked questions

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

01Should I use 27385 or 27386 for a quadriceps tendon repair?

Use 27385 for an acute, primary repair with no graft. If the rupture is old, the repair is a secondary reconstruction, or the surgeon uses fascial or tendon graft material, bill 27386 instead. Confirm with the operative note before coding.

02Can I use 27385 for an open proximal hamstring tendon repair?

Yes. A May 2025 AMA CPT Assistant correction confirmed that open proximal hamstring tendon repair is correctly reported with 27385, not unlisted code 27599. Earlier guidance from 2015 pointing to 27599 was explicitly retracted.

03Is the quadriceps tendon covered under 27385 even though it's a tendon, not a muscle belly?

Yes. The quadriceps tendon is part of the quadriceps muscle complex, so its repair is captured under 27385 for primary cases. Billing a separate tendon repair code instead is an error that auditors flag.

04What modifier applies if the same surgeon repairs both thighs at the same operative session?

Append modifier 50 for a bilateral procedure. Bilateral quadriceps or hamstring ruptures at one session are uncommon but do occur, particularly in patients with tendinopathy or systemic conditions predisposing to bilateral rupture.

05How does the 90-day global period affect post-op billing for 27385?

The 90-day global covers the surgery, the day-before visit, and all routine post-op care through day 90. Any unrelated E/M in that window needs modifier 24. A new problem evaluated same-day as the surgery needs modifier 25 on the E/M.

06When would modifier 22 apply to a 27385 claim?

Use modifier 22 when the repair was substantially more work than typical — for example, a massively retracted tendon requiring extensive mobilization, or significant scarring from prior surgery complicating the approach. Document the specific factors that increased complexity; without that, payers will deny the upcharge.

07Can 27385 be billed if a return to the OR is needed due to re-rupture within the global period?

If the re-rupture repair is unplanned and related to the original procedure, use modifier 78. If it's a planned staged revision, use modifier 58. Do not bill without a modifier during the global period — the claim will deny as bundled.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the rupture acuity (acute vs. chronic), the specific structure repaired (quadriceps tendon vs. hamstring), laterality, surgical approach, suture technique, and whether any graft material was used. That detail locks in 27385 vs. 27386 at the point of dictation and prevents the most common audit flag — operative notes that say 'thigh muscle repair' without specifying the structure, timeline, or reconstruction method.

See how Mira captures CPT 27385 documentation