Surgical · Knee

Re-amputation of the thigh through the femur at any level, performed after a prior amputation has failed or the stump requires surgical revision beyond secondary closure.

Verified May 8, 2026 · 7 sources ↓

Medicare: $660.00
Work RVU: 11.01
Global, days: 90
Region: Knee

Drawn from CMSEmednyFastrvuAxogenincMdclarity

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 must state the prior amputation level and the new resection level through the femur
Indications for re-amputation — infection, nonviable stump, prosthetic incompatibility — must be documented in the H&P or pre-op note
Stump reconstruction technique must be specified: myoplasty, myodesis, or other closure method
Laterality must be identified (left or right limb) in both the operative note and on the claim
If concurrent debridement is billed, document tissue type, surface area, and distinct medical necessity separate from the amputation itself
Inpatient admission order and supporting clinical documentation are required; this code is CMS inpatient-only (status indicator C)

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 58 Staged or related 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 27596 describes surgical re-amputation through the femur when a prior above-knee amputation has resulted in a stump that cannot be managed with secondary closure or scar revision alone (those procedures fall under 27594). The operative indication is typically stump failure — nonviable tissue, infection, or a level inadequate for prosthetic fitting — requiring formal bone resection at a new level and myoplasty or myodesis for stump reconstruction.

This is an inpatient-only procedure under CMS status indicator C. Medicare does not reimburse 27596 in the HOPD or ASC setting as a planned outpatient case. The 90-day global period begins on the date of surgery and bundles all routine post-operative stump management, dressing changes, and suture removal through day 90. Unrelated E/M visits or procedures in that window require modifier 24 or 79, respectively.

The code sits in the femur/knee amputation family alongside 27590 (primary amputation), 27591 (immediate prosthetic fitting), 27592 (open guillotine), and 27594 (secondary closure/scar revision). Laterality modifiers LT or RT are expected on single-limb claims. If debridement of bone or soft tissue is performed as a separately documented and distinct service, additional debridement codes may be reportable — document the extent and surface area to support them.

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 (11.01) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (19.76) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	11.01
Practice expense RVU	6.11
Malpractice RVU	2.64
Total RVU	19.76
Medicare national rate	$660.00
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	$660.00
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 27596 get rejected.

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

Place-of-service mismatch: billing as outpatient or ASC when 27596 is CMS inpatient-only (status indicator C)
Missing or inadequate documentation of why re-amputation was necessary rather than secondary closure (27594)
Laterality modifier absent — payers expect LT or RT on all single-limb amputation claims
Debridement codes billed same-day without documentation distinguishing them as separately identifiable services
Global period violations: routine post-op stump care billed within 90 days without modifier 24 or 79

Frequently asked questions

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

01What is the difference between CPT 27594 and CPT 27596?

27594 covers secondary closure or scar revision of a healed or granulated stump — no bone resection required. 27596 is re-amputation: the femur is transected at a new, more proximal level. Bill 27596 when bone is resected; bill 27594 when the surgeon is revising soft tissue only.

02Can 27596 be performed in an ASC or outpatient hospital?

No. CMS assigns status indicator C to 27596, making it inpatient-only under Medicare. Outpatient or ASC claims will be denied. Medicaid and commercial payer rules vary — verify individually — but Medicare is absolute on this.

03Do I need a laterality modifier on 27596?

Yes. Append LT or RT. Re-amputation is inherently a unilateral procedure, and omitting laterality triggers edits from most payers. Modifier 50 is not applicable here.

04Can I bill debridement codes on the same day as 27596?

Only if the debridement is a distinct, separately documented service — different tissue type, different anatomic area, or a clearly separate medical necessity. Document tissue type and surface area explicitly. Bundling edits will deny debridement that reads as part of the amputation wound prep.

05How does the 90-day global period affect post-op stump care billing?

All routine stump management — dressing changes, suture removal, prosthetic-fitting visits related to the surgical site — is bundled into the global. Use modifier 24 for unrelated E/M visits during the global and modifier 79 for an unrelated surgical procedure. Modifier 78 applies if the patient returns to the OR for an unplanned procedure related to the re-amputation.

06What ICD-10 diagnoses typically support 27596?

Common supporting diagnoses include traumatic or surgical stump complications (T87 series), osteomyelitis of the residual limb, peripheral vascular disease with gangrene (I70.26x series), and diabetic complications with tissue necrosis. The diagnosis must reflect why re-amputation — not just revision — was medically necessary.

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 prior amputation level, the new femoral resection level, the operative indication (infection, nonviable tissue, or inadequate stump length), and the stump reconstruction technique from the surgeon's dictation. It also flags laterality and whether concurrent debridement was performed as a distinct service. That documentation chain is what separates a clean 27596 claim from a denial for lack of medical necessity or a downcode to 27594.

See how Mira captures CPT 27596 documentation