Transfer or transplant of multiple tendons in the thigh, involving muscle redirection or rerouting — for example, moving an extensor tendon to function on the flexor side.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $856.40
- Total RVUs
- 25.64
- 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 ↓
- Identify each tendon transferred or transplanted by name — vague references to 'multiple tendons' invite audits
- Document the direction of rerouting (e.g., extensor-to-flexor) and the functional goal of the transfer
- State the clinical indication: paralysis, nerve injury, spasticity, or other diagnosis driving the reconstruction
- Describe the surgical technique for each tendon: harvest site, rerouting path, fixation method, and tension setting
- Record intraoperative assessment of muscle tension and range-of-motion testing after fixation
- Confirm in the operative note that this involved multiple tendons — single-tendon transfers code differently
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 27397 covers surgical transfer or transplantation of multiple thigh tendons with muscle redirection or rerouting. The classic example is transposing an extensor tendon to the flexor side so it functions as a flexor — a technique used in paralytic conditions, nerve injury sequelae, or complex reconstructive scenarios where motor function must be redistributed across the thigh. This is not a single-tendon repair; the code requires multiple tendons and intentional rerouting of muscle mechanics.
The procedure carries a 90-day global period. All routine post-op visits, wound checks, and stitch removals through day 90 are bundled. Anything unrelated billed in that window needs modifier 24 or 25. If a staged or unplanned related procedure is required in the global period, append modifier 78. An unrelated procedure in the global window takes modifier 79.
Site of service matters here. HOPD and ASC payments differ materially — see the Site of Service comparison on this page. Bilateral cases are uncommon but possible; append modifier 50 and confirm payer policy, as some carriers require separate line items with LT/RT instead.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 12.34 |
| Practice expense RVU | 10.68 |
| Malpractice RVU | 2.62 |
| Total RVU | 25.64 |
| Medicare national rate | $856.40 |
| 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 | $856.40 |
HOPD (APC 5114) Hospital outpatient department | $7,413.38 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $5,459.27 |
Common denial reasons
The recurring reasons claims for CPT 27397 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Operative note documents only one tendon transferred, failing to support the 'multiple tendons' requirement of 27397
- Medical necessity not established — diagnosis codes do not reflect a condition requiring tendon rerouting (e.g., no documented neurological deficit, paralysis, or functional loss)
- Bundled denial when payer considers 27397 included in a concurrent knee reconstruction or arthroplasty code billed same-day without modifier 59 or XS
- Missing documentation of the rerouting or redirection component — notes that describe repair rather than transfer/transplant with muscle redirection are flagged
- Global period conflict: post-op visit billed without modifier 24 when the treating surgeon is still within the 90-day global window
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01Does 27397 require a minimum number of tendons?
02Is tendon harvesting for an ACL repair billable with 27397?
03What modifiers apply when 27397 is performed bilaterally?
04What is the global period for 27397, and what's bundled into it?
05Can 27397 be billed same-day with a knee arthroplasty or other major knee procedure?
06What ICD-10 diagnoses most commonly support 27397?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
Mira AI Scribe
Mira's AI scribe captures each tendon by name, the direction of rerouting, fixation technique, and intraoperative tension/ROM assessment directly from dictation. That detail prevents the two most common denials for 27397: notes that describe a single tendon (failing the 'multiple' threshold) and notes that read as a repair rather than a functional transfer with muscle redirection.
See how Mira captures CPT 27397 documentation