Surgical · Other

Transfemoral (above-knee) amputation performed at any level through the femur, with wound closure using residual muscle and skin flaps.

Verified May 8, 2026 · 5 sources ↓

Medicare: $721.13
Total RVUs: 21.59
Global, days: 90
Region: Other

Drawn from CMSAAPCFindacode

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Operative note must specify the exact level of femoral transection — not just 'above-knee amputation.'
Document the indication: vascular insufficiency, trauma, infection, malignancy, or other, with supporting clinical findings.
Describe the closure technique — myoplasty, myodesis, or skin-only flap — and the condition of residual soft tissue.
Pre-operative vascular or imaging workup (ABI, angiography, MRI) supporting level selection should be in the chart.
If modifier 22 is used, document specific factors that increased intraoperative complexity and time beyond the typical case.
Consent and informed decision-making note addressing level of amputation and prosthetic rehabilitation plan.

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 51 Multiple procedures 52 Reduced services 58 Staged or related 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 27590 covers amputation of the lower extremity performed through the femoral shaft at any level — from just below the femoral neck to just above the knee. The surgeon transects the femur, shapes the residual limb, and closes the wound using available myoplasty or myodesis techniques along with skin flaps. The level is dictated by tissue viability, vascular perfusion, and the goal of achieving a durable, prosthesis-compatible stump.

This code carries a 90-day global period. All routine post-op visits, wound checks, suture removal, and stump-shaping decisions within that window are bundled. Separate billing for complications managed in the OR during the global period requires modifier 78 (related return) or modifier 79 (unrelated procedure). Vascular surgery and orthopedic surgery are the two dominant billing specialties — the underlying pathology (peripheral arterial disease vs. trauma or tumor) typically determines who leads the case.

Assistant surgeon services are recognized for this code; bill the assisting surgeon under modifier 80 or AS for mid-level practitioners. If the procedure is substantially more complex than typical — extensive debridement of necrotic tissue, vascular reconstruction performed in the same operative field, or prolonged wound management — modifier 22 applies with supporting documentation of the added work and time.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	13.13
Practice expense RVU	5.19
Malpractice RVU	3.27
Total RVU	21.59
Medicare national rate	$721.13
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	$721.13
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI G2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 27590 get rejected.

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

Operative note vague on femoral level — payers flag 'standard above-knee amputation' without anatomic specificity.
Missing pre-op vascular or oncologic workup to justify medical necessity of amputation vs. limb salvage.
Assistant surgeon (modifier 80 or AS) denied when payer policy requires demonstration of medical necessity for surgical assistance.
Modifier 22 attached without a separate supporting letter quantifying added operative time and complexity.
Post-op visits billed without modifier 24 during the 90-day global period, triggering automatic bundling denial.

Frequently asked questions

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

01Does 27590 cover any level of transfemoral amputation, or are there separate codes for different femoral levels?

27590 covers amputation through the femur at any level — proximal, mid-shaft, or supracondylar. There is no separate CPT for each femoral level. The level must be documented, but it doesn't change the code.

02How do you bill a post-op visit for a wound complication during the 90-day global period?

If the complication is managed in the office, append modifier 24 to the E/M code to indicate it's unrelated to routine post-op care. If it requires a return to the OR for a related procedure, use modifier 78 on the surgical code.

03Can you bill 27590 bilaterally?

Bilateral transfemoral amputations performed in a single operative session are extraordinarily rare, but if billed, append modifier 50 or LT/RT as required by the specific payer. Most payers will require documentation explaining the clinical circumstances and may require separate operative notes for each limb.

04Is an assistant surgeon reimbursable for 27590?

Yes. CMS recognizes assistant surgeon services for this code. Bill with modifier 80 for a physician assistant surgeon or modifier AS for a PA or NP acting as surgical assistant. Some payers require documentation that the assistant was medically necessary.

05When is modifier 22 appropriate for 27590?

Use modifier 22 when the case required substantially greater work than typical — for example, extensive debridement of infected or necrotic tissue, complex vascular anatomy, or re-amputation through a failed prior stump. Attach a cover letter specifying added operative time and the clinical factors driving increased complexity. Without that letter, modifier 22 claims are routinely downcoded or denied.

06What ICD-10 diagnoses most commonly support 27590?

Peripheral artery disease with gangrene (I70.26x), diabetic peripheral angiopathy with gangrene (E11.52), traumatic amputation of the thigh (S78.x), and malignant neoplasm of the femur (C40.2x) are the most common supporting diagnoses. The selected ICD-10 code must align with the documented clinical indication for amputation.

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 femoral transection level, closure method (myoplasty vs. myodesis), tissue and vascular conditions at the stump, and the clinical rationale for amputation over limb salvage — directly from dictation. That prevents the single most common audit flag on 27590: an operative note that documents the outcome but not the intraoperative decision-making, which payers use to challenge medical necessity.

See how Mira captures CPT 27590 documentation