Transplantation of a single hamstring tendon to the patella, redirecting or rerouting thigh musculature to restore knee extensor or flexor function.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $588.52
- Work RVU
- 7.95
- Global, days
- 90
- Region
- Knee
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 5 cited references ↓
- Specify which hamstring tendon was transplanted (e.g., semitendinosus, gracilis, biceps femoris) — not just 'hamstring tendon'.
- Document the indication clearly: why tendon transplantation was chosen over primary repair or other reconstruction options.
- Describe the rerouting or redirection technique used, including harvest site, preparation of the patellar attachment, and fixation method.
- Confirm single-tendon procedure in the operative note; if multiple tendons were transferred, 27397 applies instead.
- Record neurovascular status of the extremity pre- and post-procedure, especially if underlying neurologic etiology (e.g., peroneal nerve palsy) is the indication.
- Laterality must be documented and reported with LT or RT modifier; operative note should name the operative limb explicitly.
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 5 cited references ↓
CPT 27396 covers transplantation of a single hamstring tendon to the patella — a procedure in which the surgeon detaches a hamstring tendon and reattaches it to the patella to redirect muscle force, typically converting a flexor to an extensor mechanism or restoring active knee extension when the quadriceps mechanism is compromised. The code sits within the Repair, Revision, and/or Reconstruction section for the femur (thigh region) and knee joint. When multiple tendons are transplanted in the same session, use 27397 instead — 27396 is strictly single-tendon.
The 90-day global period means all routine follow-up through day 90 is bundled. Post-op visits for wound checks, suture removal, and progression of weight-bearing are not separately billable unless the visit addresses an unrelated problem (modifier 24) or a distinct new problem requiring significant additional E/M work (modifier 25). A staged revision or reoperation for a related reason during the global window requires modifier 58; an unrelated procedure requires modifier 79.
Site of service matters here. The HOPD and ASC payments differ substantially — see the site-of-service comparison on this page. Most payers require prior authorization for elective tendon transplant procedures, and medical necessity documentation must tie the clinical indication (e.g., quadriceps rupture with failed primary repair, paralytic conditions, post-traumatic extensor mechanism loss) directly to the chosen reconstruction technique.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (7.95) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (17.62) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 7.95 |
| Practice expense RVU | 7.98 |
| Malpractice RVU | 1.69 |
| 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 27396 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Medical necessity not established — payer requires documentation of failed conservative treatment or prior surgical attempt before approving elective tendon transplantation.
- Code billed as 27396 when multiple tendons were transferred in the same session; should be 27397, causing a mismatch between the operative note and the submitted code.
- Missing or incorrect laterality modifier (LT/RT) causes claim suspension or denial on first pass.
- Prior authorization not obtained or obtained for the wrong procedure code before surgery.
- Post-op E/M visits billed without modifier 24 or 25 during the 90-day global period, triggering automatic bundling denial.
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01What is the difference between 27396 and 27397?
02Can 27396 and 27397 both be billed on the same day for bilateral procedures?
03Does the 90-day global period cover physical therapy referrals?
04What ICD-10 diagnoses support medical necessity for 27396?
05If the surgeon harvests a tendon graft during the same session, is that separately billable?
06When is modifier 22 appropriate for 27396?
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 tendon harvested, the recipient site (patellar attachment), the fixation technique, and the surgeon's stated rationale for tendon transplantation versus alternative reconstruction. It also flags single- versus multiple-tendon language to distinguish 27396 from 27397 at the point of dictation. That prevents the single most common coding error on this procedure — billing 27396 when the operative note clearly describes two tendons — which triggers a mismatch denial on audit.
See how Mira captures CPT 27396 documentation