Secondary reconstruction of a ruptured quadriceps or hamstring muscle using a fascial or tendon graft harvested from the patient's own tissue.

Verified May 8, 2026 · 7 sources ↓

Medicare: $807.30
Total RVUs: 24.17
Global, days: 90
Region: Knee

Drawn from AAPCCMSCgsmedicareEmednyAbos

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify whether the ruptured muscle is quadriceps or hamstring — both are covered but must be identified by name.
Document the reason secondary reconstruction is required: failed primary repair, delayed presentation, or retracted/scarred tissue preventing direct suture.
Identify the graft source by tissue type and harvest site (e.g., autogenous fascia lata from the lateral thigh, semitendinosus tendon).
Describe the surgical technique used to bridge the defect, including graft fixation method and any anchoring hardware used.
Note laterality (right vs. left) explicitly in the operative report heading and body.
Record time elapsed since the original muscle rupture or since the failed primary repair, which establishes the medical necessity basis for secondary reconstruction.

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 62 Co-surgeons 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 7 cited references ↓

CPT 27386 covers secondary reconstruction of a quadriceps or hamstring muscle rupture — performed either when a primary repair has failed or when the initial injury was addressed days to weeks after rupture, making direct re-approximation inadequate. The procedure requires harvesting autogenous fascia or tendon graft material to bridge the defect and restore continuity of the extensor or flexor mechanism. This is the graft-dependent counterpart to 27385, which covers primary suture repair without graft.

The 90-day global period means all routine post-op visits, wound checks, and dressing changes through day 90 are bundled into the 27386 payment. Any E&M service during that window for a problem unrelated to the reconstruction requires modifier 24. A staged or planned procedure during the global period requires modifier 58; an unplanned return to the OR for a related complication bills with modifier 78.

Graft harvest is integral to 27386 and is not separately reportable — the descriptor explicitly includes fascial or tendon graft procurement. Billing a separate graft harvest code alongside 27386 will trigger an NCCI bundling denial. When the procedure is performed on a single, identifiable limb, append LT or RT to localize the site; modifier 50 applies only if bilateral reconstruction is performed in the same operative session.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.85
Practice expense RVU	11.1
Malpractice RVU	2.22
Total RVU	24.17
Medicare national rate	$807.30
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	$807.30
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 27386 get rejected.

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

Billing graft harvest (e.g., a separate soft-tissue graft code) in addition to 27386 — graft procurement is bundled into the descriptor and is not separately payable.
Missing or vague documentation of why secondary reconstruction was necessary rather than primary repair; payers audit for clinical justification.
Laterality not specified — claims without LT or RT are frequently rejected by commercial payers that require side identification for extremity procedures.
Billing 27385 (primary suture) when the operative note describes graft use; the codes are mutually exclusive and the wrong code selection triggers downcoding or denial.
Routine post-op E&M visits billed separately during the 90-day global period without modifier 24 and an unrelated diagnosis to support them.

Frequently asked questions

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

01What makes a repair 'secondary' for 27386 versus 'primary' for 27385?

Secondary means the surgeon is reconstructing the muscle at least several days after the original rupture, or revising a failed prior repair. A same-session repair of an acute rupture using direct suture is 27385. If a graft is required to bridge a retracted or scarred defect — regardless of how much time has passed — 27386 is the correct code.

02Can I separately bill for harvesting the fascia or tendon graft?

No. The 27386 descriptor explicitly includes fascial or tendon graft procurement. Billing a separate harvest code alongside 27386 is an NCCI bundling violation and will deny. The graft harvest is integral to and included in the procedure payment.

03What modifier applies if this procedure is performed during the global period of a previous knee surgery?

Use modifier 58 if the reconstruction was staged or planned as a follow-on to the prior procedure. Use modifier 78 if the patient returned to the OR unexpectedly for a complication related to the prior surgery. Modifier 79 applies only if 27386 is entirely unrelated to the original procedure — for example, the prior surgery was on the contralateral limb.

04Does 27386 require a specific diagnosis code to avoid medical necessity denial?

Yes. The ICD-10-CM code should reflect either a rupture of the quadriceps or hamstring muscle (M62.1x or traumatic equivalent under S76.xx) and ideally indicate the chronic, delayed, or post-repair-failure nature that necessitates secondary reconstruction. Acute traumatic codes alone without documentation of secondary status can trigger payer scrutiny.

05Is 27386 payable in an ASC setting?

Yes. The procedure has an ASC payment rate under CMS — see the Site of Service comparison on this page. HOPD payment is higher; the site-of-service differential is material enough to factor into where you schedule the case.

06Can 27386 and 27381 (secondary infrapatellar tendon reconstruction) be billed together?

Only if both were performed as separate, distinct procedures with independent clinical indications. You would need modifier 59 (or XS) and documentation clearly establishing that each repair addressed a different structure. NCCI edits for this combination should be confirmed via the CMS PTP lookup before billing both on the same date.

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 muscle involved (quadriceps vs. hamstring), the reason primary repair was not performed or was insufficient, the graft tissue type and harvest site, laterality, and fixation technique — all from surgeon dictation. That prevents the two most common audit flags: an operative note that says only 'secondary reconstruction with graft' without specifying why, and missing laterality that triggers a commercial payer rejection before the claim reaches a human reviewer.

See how Mira captures CPT 27386 documentation