Secondary closure or scar revision following transfemoral amputation, performed after the initial through-femur amputation wound is prepared for definitive closure.

Verified May 8, 2026 · 7 sources ↓

Medicare: $477.97
Work RVU: 7.11
Global, days: 90
Region: Other

Drawn from CMSJvascsurgAxogenincAAOSAAPC

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 from the index amputation documenting intent for staged closure if modifier 58 is used
Description of stump condition at time of 27594 — granulation status, infection resolution, wound margins
Explicit statement of the procedure performed: secondary closure vs. scar revision vs. stump revision with bone involvement
Anatomic level of the amputation site and any change in level during the 27594 procedure
ICD-10 diagnosis code(s) that justify return to OR — separate from index amputation diagnosis if modifier 79 is applied
Date of index amputation and calculation confirming 27594 falls within or outside the 90-day global period

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 58 Staged or related 59 Distinct service 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 27594 covers the return trip to the OR for secondary closure or scar revision at a transfemoral (above-knee) amputation site. The classic scenario: an emergent guillotine amputation through the femur (27592) or knee disarticulation (27598) is performed first — often for sepsis or critical limb ischemia — and once the infection is controlled and the tissue begins to granulate, 27594 is billed for the definitive closure or revision procedure.

Because the initial amputation carries a 90-day global period, 27594 almost always falls inside that window. The correct modifier depends on how the return was planned. Staged, anticipated closures after a guillotine amputation get modifier 58 — the surgeon should document intent to return in the original operative note. Unplanned returns for a complication get modifier 78. Either way, the global clock for the primary code is not reset by 27594.

Document the specific reason for return (wound dehiscence, scar revision, delayed primary closure), the condition of the stump at the time of 27594, and the exact level of revision performed. Payers will scrutinize operative notes when two amputation-related codes appear on claims within the same global period — vague language in either note is the most common audit trigger.

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 (7.11) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (14.31) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.11
Practice expense RVU	5.53
Malpractice RVU	1.67
Total RVU	14.31
Medicare national rate	$477.97
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	$477.97
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 27594 get rejected.

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

Modifier missing or wrong — 27594 billed without 58 or 78 inside the 90-day global of the index amputation, triggering a bundling denial
Modifier 58 used without documented staged intent in the original operative note, causing medical review failure
Diagnosis codes on 27594 claim identical to index procedure without clinical justification for the return encounter
Facility site-of-service mismatch — procedure billed at ASC rate when performed in a hospital outpatient setting or vice versa
Insufficient operative note detail — 'secondary closure performed' without description of wound status, technique, or level revisions

Frequently asked questions

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

01Which modifier goes on 27594 when it follows an emergent guillotine amputation (27592) within the global period?

Modifier 58 — staged procedure. The guillotine-then-close sequence is the textbook staged scenario. Document the intent to return in the original 27592 operative note. If the closure was truly unplanned due to a complication, use modifier 78 instead, but staged guillotine closures are planned by definition.

02Does billing 27594 with modifier 58 reset the 90-day global period?

Yes. Modifier 58 resets the global clock from the date of the 27594 procedure. Modifier 78 does not reset the global — the original period continues to run from the index amputation date.

03Can 27594 be billed for a stump revision that involves bone resection?

27594 is specifically for secondary closure or scar revision. Procedures involving formal bone revision or higher-level re-amputation have their own codes. If the operative note describes bone work beyond minor contouring for closure, review whether a higher-level amputation code is more accurate.

04Is 27594 payable in an ASC setting?

Yes — Medicare assigns an ASC payment for 27594. The rate differs from the HOPD rate, so verify site-of-service before submitting. See the site-of-service comparison table on this page for current 2026 figures.

05When a vascular surgeon performed the index amputation and an orthopaedic surgeon performs 27594, which modifier applies?

Modifier 79 — unrelated procedure by the same or different physician during the postoperative period is the framework, but when a different physician is handling the secondary closure, the 90-day global of the index surgeon does not automatically bind the second surgeon. Bill without a global-period modifier if the surgeons are in different groups. Confirm payer policy; some commercial payers require modifier 79 regardless.

06What ICD-10 codes are appropriate with 27594?

Use the complication or sequela code that justifies the return — wound dehiscence, delayed healing, or late effect of amputation. Do not simply carry forward the original limb-loss or ischemia diagnosis without adding the specific condition requiring the closure procedure. Mismatched or recycled diagnosis codes are a top denial trigger for this code.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the stump condition at time of closure (granulation status, wound margins, infection resolution), the specific procedure performed (secondary closure vs. scar revision), any change in amputation level, and whether the return was staged or unplanned. That language directly determines whether modifier 58 or 78 is correct — the most common denial point for this code inside a 90-day global period.

See how Mira captures CPT 27594 documentation