Surgical lengthening of multiple hamstring tendons in both legs simultaneously, performed through open incisions along the posterior thighs.

Verified May 8, 2026 · 7 sources ↓

Medicare: $822.33
Total RVUs: 24.62
Global, days: 90
Region: Knee

Drawn from CMSAAPCQproFastrvuHca

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Operative note must name all tendons lengthened (biceps femoris, semitendinosus, semimembranosus) on each side — 'multiple hamstrings' alone is insufficient for audit purposes.
Confirm bilateral involvement is documented in the pre-op assessment and the operative note — both legs must be explicitly described as treated.
Specify the lengthening technique used (e.g., Z-plasty, fractional intramuscular lengthening, tenotomy) for each tendon and each side.
Document the medical necessity: diagnosis of spastic diplegia, cerebral palsy-related contracture, or equivalent condition with measurable popliteal angle or gait analysis findings.
Record pre-operative range of motion measurements and/or gait findings to support functional impairment and justify bilateral approach.
Anesthesia type and patient positioning documented; general or regional anesthesia typical for this procedure.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 59 Distinct service 62 Co-surgeons 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 7 cited references ↓

CPT 27395 covers open lengthening of multiple hamstring tendons — biceps femoris, semitendinosus, and/or semimembranosus — performed bilaterally in a single operative session. The surgeon makes incisions along the posterior thighs, exposes the tendons, and elongates them through cutting or fractional lengthening techniques to reduce spasticity or fixed-flexion contracture. This code is distinct from 27393 (single tendon, one leg) and 27394 (multiple tendons, one leg).

The bilateral nature is built into the code descriptor itself. That has a critical billing implication: Medicare already prices 27395 at 150% to account for both sides. Do not append modifier 50 or bill two units — doing so triggers a 300% payment and constitutes incorrect billing. Washington State Medicaid explicitly names this code as one that must not be billed with modifier 50 for this reason.

The 90-day global period covers all routine post-op management, physical therapy oversight visits billed by the operating surgeon, and dressing changes through day 90. Unrelated E/M visits during the global window require modifier 24. A staged or planned return to the OR for a related procedure requires modifier 78; an unrelated procedure requires 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	11.93
Practice expense RVU	10.15
Malpractice RVU	2.54
Total RVU	24.62
Medicare national rate	$822.33
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	$822.33
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 27395 get rejected.

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

Modifier 50 appended or two units billed — 27395 is already priced bilaterally; this triggers overpayment and will deny or recoup.
Insufficient specificity in the operative note — failing to name the individual tendons lengthened on each side flags the claim in audit.
Medical necessity not established — missing objective measures (popliteal angle, gait analysis, prior conservative treatment failure) leads to payer denial.
Bundling conflict when same-session hamstring procedures are billed separately without appropriate modifier and distinct documentation.
Global period violation — routine post-op E/M visits billed without modifier 24 during the 90-day global are automatically denied.

Frequently asked questions

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

01Can I bill modifier 50 with 27395 to indicate bilateral work?

No. The code descriptor specifies bilateral — Medicare prices it accordingly at 150%. Adding modifier 50 or billing two units results in 300% payment, which is incorrect billing and subject to recoupment.

02What is the global period for 27395 and what does it include?

27395 carries a 90-day global period. All routine post-op visits, wound checks, and dressing changes billed by the operating surgeon are bundled through day 90. Use modifier 24 for unrelated E/M visits during that window.

03How does 27395 differ from 27393 and 27394?

27393 covers a single hamstring tendon on one leg. 27394 covers multiple tendons on one leg. 27395 covers multiple tendons on both legs in the same session. Choose based on tendon count and laterality as documented in the operative note.

04What ICD-10 diagnoses typically support 27395?

Spastic diplegia from cerebral palsy is the most common indication. Other supporting diagnoses include acquired muscle contracture, hamstring spasticity from upper motor neuron disorders, and gait abnormality with documented fixed-flexion contracture. The diagnosis must link to bilateral, multi-tendon involvement.

05If the surgeon only lengthens tendons on one side intraoperatively, should 27395 still be billed?

No. If intraoperative findings limit the procedure to one leg, bill 27394 (multiple tendons, unilateral). Billing 27395 for a unilateral procedure misrepresents the service performed and exposes the claim to fraud risk.

06Can 27395 be billed with other knee or thigh procedures on the same day?

It can, but NCCI edits apply. Use modifier 59 or an X modifier with appropriate documentation when a distinct, separately identifiable procedure is performed. Check the NCCI PTP lookup tool for specific code pairs before submitting.

07Does the site of service affect payment for 27395?

Yes. The HOPD rate and ASC rate differ significantly — see the site of service comparison table on this page. The professional component (surgeon's fee) also adjusts based on facility vs. non-facility setting.

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 specific tendons lengthened on each side, the technique used (Z-plasty, fractional lengthening, tenotomy), bilateral confirmation, pre-op popliteal angle measurements, and the underlying diagnosis driving the procedure. This prevents the most common audit flag for 27395 — operative notes that reference 'hamstrings' without identifying individual structures or confirming bilateral treatment in the body of the note.

See how Mira captures CPT 27395 documentation