Open surgical division of multiple hamstring tendons — biceps femoris, semitendinosus, and/or semimembranosus — performed bilaterally from knee to hip in a single operative session.

Verified May 8, 2026 · 5 sources ↓

Medicare: $673.70
Total RVUs: 20.17
Global, days: 90
Region: Knee

Drawn from CMSAAOSAbos

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Identify each tendon released by name (biceps femoris, semitendinosus, semimembranosus) and specify laterality for each
Confirm multiple tendons were cut on both legs — a single tendon per side does not satisfy 27392
Document the clinical indication, such as spastic hamstring contracture with quantified range-of-motion limitation
Record the surgical approach and extent of release for each tendon division
If modifier 22 is appended, document specific factors that made the work substantially greater than typical, such as severe scarring or prior surgical history

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 51 Multiple procedures 57 Decision for surgery 58 Staged or related 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 27392 covers open tenotomy of multiple hamstring tendons performed on both legs in the same operative encounter. The hamstring group — biceps femoris, semitendinosus, and semimembranosus — runs from the ischial tuberosity to the proximal tibia and fibula. Surgical division of multiple tendons bilaterally is typically indicated for spastic or contracture conditions causing significant functional impairment, such as those seen in cerebral palsy or other neuromuscular disorders.

The bilateral, multi-tendon scope is what separates 27392 from its sibling codes. CPT 27390 covers a single tendon, one leg. CPT 27391 covers multiple tendons, one leg. CPT 27392 requires documentation that multiple tendons were released on each side — not just a single tendon bilaterally. If only one tendon was cut on one or both sides, the more specific lower-tier code applies.

The 90-day global period governs all routine post-op care through day 90. Staged procedures planned at the initial operation require modifier 58. Unplanned returns to the OR for a related issue use modifier 78; for an unrelated procedure, modifier 79. Decision for surgery made the day of or day before the procedure requires modifier 57 on the associated E/M code.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.39
Practice expense RVU	8.78
Malpractice RVU	2
Total RVU	20.17
Medicare national rate	$673.70
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	$673.70
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 27392 get rejected.

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

Billing 27392 when operative note documents only one tendon per leg — downcode to 27391 or 27390
Missing laterality documentation that confirms bilateral procedure was performed
Lack of supporting diagnosis linking the contracture or spasticity to the need for bilateral multi-tendon release
Routine post-op E/M billed without modifier 24 during the 90-day global period
Modifier 50 appended instead of using 27392 directly — 27392 is already a bilateral code and does not take modifier 50

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Does 27392 require modifier 50 since it's bilateral?

No. CPT 27392 is inherently bilateral — 'bilateral' is built into the code descriptor. Appending modifier 50 will cause a duplicate-billing flag. Bill 27392 once with no laterality modifier.

02What's the difference between 27391 and 27392?

27391 is multiple tendons, one leg. 27392 is multiple tendons, both legs in the same session. If you only operated on one side, 27391 is the correct code regardless of how many tendons were released.

03Can 27392 and 27393–27395 (hamstring lengthening) be billed together?

Only if the tenotomy and lengthening were performed on distinct tendons at separate anatomic sites. Check current NCCI PTP edits before billing both; if bundled, modifier 59 or XS applies only when the work is genuinely distinct and documentation supports it.

04What ICD-10 diagnoses typically support 27392?

Spastic diplegia or hemiplegia (G80.x), contracture of muscle at thigh (M62.45x), and acquired deformity of lower limb (M21.x) are the most common supporting diagnoses. The diagnosis must reflect bilateral involvement to match the bilateral procedure.

05How does the 90-day global affect post-op physical therapy orders and E/M visits?

PT orders are not billed under the surgeon's NPI, so they are unaffected by the global. E/M visits by the operating surgeon for routine post-op care within 90 days are included in the global and cannot be billed separately. If the E/M addresses an unrelated problem, append modifier 24 and document the unrelated condition explicitly.

06When is modifier 22 justified on 27392?

Modifier 22 is appropriate when documented circumstances — severe adhesions from prior surgery, extreme contracture requiring unusual dissection, or significantly prolonged operative time — made the work substantially greater than typical. The operative note must name the complicating factor; increased time alone is insufficient without narrative explanation.

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 name of each tendon divided, the surgical approach used for each release, and explicit bilateral confirmation from the operative dictation. This prevents the most common downcode scenario — a note that says 'hamstring tenotomy bilateral' without specifying which tendons were cut on each side — which auditors and payers use to deny 27392 in favor of the single-tendon unilateral code.

See how Mira captures CPT 27392 documentation