Fasciotomy releasing multiple compartments of the thigh and/or knee to relieve elevated intracompartmental pressure, without debridement of nonviable tissue.

Verified May 8, 2026 · 6 sources ↓

Medicare: $624.93
Work RVU: 8.44
Global, days: 90
Region: Knee

Drawn from CMSAbosAAPCFindacodeMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify each compartment released by name (e.g., anterior, posterior, medial/adductor) — 'multiple compartments' without enumeration is insufficient.
Document the clinical indication: measured compartment pressures, or clinical signs of compartment syndrome with decision rationale if pressures were not measured.
Describe fasciotomy technique and length of each incision made for each compartment released.
Record neurovascular assessment performed intraoperatively and findings at closure or wound packing.
Note whether debridement of nonviable muscle or nerve was performed — if yes, 27499 applies instead.
For trauma cases, document the precipitating injury and timeline from injury to surgical intervention.

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 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27498 covers a decompression fasciotomy of the thigh and/or knee involving multiple compartments — flexor, extensor, and/or adductor — performed to relieve acute or chronic compartment syndrome. It sits one step above 27496 (single compartment, no debridement) and 27497 (single compartment with debridement) in the fasciotomy ladder, and one step below 27499, which adds debridement of nonviable muscle or nerve. The multi-compartment distinction is the critical coding factor: if the operative note documents only one compartment released, the correct code drops to 27496 or 27497.

This is a 90-day global procedure. All routine postoperative care — wound checks, dressing changes, suture removal — is bundled through day 90. E/M visits during the global window for unrelated problems need modifier 24; a same-day E/M that drives the surgical decision needs modifier 25. An unplanned return to the OR for a complication tied to the fasciotomy bills with modifier 78; an unrelated procedure in the global period uses modifier 79.

Because thigh compartment syndrome often arises in trauma or crush-injury contexts, 27498 may be billed alongside fracture fixation or vascular repair codes on the same operative session — modifier 51 on the lower-RVU procedure, and modifier 59 (or XS) where NCCI edits apply. Confirm NCCI PTP edits before billing 27498 with any concurrent thigh or knee 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 vs. total RVU

The work RVU (8.44) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (18.71) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	8.44
Practice expense RVU	8.48
Malpractice RVU	1.79
Total RVU	18.71
Medicare national rate	$624.93
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	$624.93
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 27498 get rejected.

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

Single-compartment documentation billed as 27498 — payer downcodes to 27496 or 27497.
Missing compartment pressure measurements or inadequate clinical rationale for emergent fasciotomy without manometry.
Bundling conflict when billed same-day with an overlapping thigh or knee procedure without modifier 59 or XS to establish distinct service.
Postoperative E/M visits billed without modifier 24 during the 90-day global period, triggering automatic denial.
Laterality not specified — claims without LT or RT modifier may reject under payer edits requiring side designation for unilateral procedures.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What is the difference between 27498 and 27499?

27498 is fasciotomy of multiple thigh/knee compartments without debridement. 27499 adds debridement of nonviable muscle and/or nerve. If the operative note documents tissue removed as nonviable, bill 27499, not 27498.

02How many compartments must be released to justify 27498 over 27496?

Two or more compartments. 27496 covers a single compartment (no debridement); 27497 covers a single compartment with debridement. Document each compartment by name to defend the multi-compartment code.

03Can 27498 be billed bilaterally?

Yes. Append modifier 50 for bilateral fasciotomy performed in the same operative session, or use LT and RT on separate line items depending on payer preference. Bilateral surgery indicator for this code allows modifier 50.

04If compartment syndrome develops post-fracture fixation and I return to the OR same day, how do I bill?

Bill 27498 with modifier 78 if the return is for a complication related to the initial procedure performed during the same global period. Modifier 78 triggers a new global period and reduces payment to the intraoperative component only.

05Does the 90-day global include the wound care visits typically needed after an open fasciotomy?

Yes. Routine wound checks, dressing changes, and delayed closure or skin grafting planning visits are bundled. Skin graft or secondary closure procedures are separate CPT codes billed with modifier 58 (staged procedure) if planned, or 78 if unplanned and related.

06Do I need compartment pressure measurements documented to bill 27498?

CMS does not mandate a specific pressure threshold, but medical necessity must be established. Document measured pressures when taken. If clinical signs alone drove the decision (e.g., trauma setting, altered mental status), document the clinical findings and rationale explicitly — vague notes are the primary audit trigger.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures each compartment released by name directly from dictation, flags whether debridement of nonviable tissue was performed (the 27498-vs-27499 fork), and records compartment pressure values or the clinical rationale used in lieu of manometry. This prevents the most common audit flag — operative notes that say 'multiple compartments' without identifying them — and supports the medical necessity record insurers request on compartment syndrome claims.

See how Mira captures CPT 27498 documentation