Incision and drainage of a deep abscess or hematoma located in the leg or ankle region, requiring surgical access to a deep tissue collection.

Verified May 8, 2026 · 7 sources ↓

Medicare: $544.77
Total RVUs: 16.31
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCFindacodeMdclarityAAOS

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Confirm depth of the abscess or hematoma — documentation must distinguish deep from superficial to support 27603 over a skin-level I&D code
Operative note must describe the incision location, depth of dissection, character and volume of material evacuated, and irrigation performed
Specify the anatomic site within the lower leg or ankle (e.g., posterior calf, lateral ankle, anterior tibial compartment)
Document the clinical indication — infection with purulent collection, traumatic hematoma, or other fluid accumulation requiring surgical drainage
Record anesthesia type used, which supports the complexity level of the procedure
Note wound management at closure — whether packed open, partially closed, or primarily closed — as this affects follow-up coding

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 57 Decision for surgery 58 Staged or related 59 Distinct service 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 27603 covers surgical incision and drainage of a deep abscess or hematoma in the lower leg or ankle. The depth qualifier matters here — this code is for deep collections, not superficial skin lesions. The surgeon opens the tissue down to the infected or hemorrhagic pocket, evacuates the contents, and typically irrigates the cavity. General or regional anesthesia is commonly used given the depth of dissection.

27603 carries a 90-day global period. That window covers the operative day, the day-before visit, and all routine follow-up care through day 90. Any E/M visit for an unrelated problem during that period needs modifier 24. A same-day E/M that represents a separately identifiable decision — for example, evaluating the patient before committing to surgical drainage — needs modifier 57, since this is a major procedure with a 90-day global.

Top billing specialties are podiatry, plastic and reconstructive surgery, and orthopedic surgery. Site of service affects payment meaningfully — see the HOPD versus ASC comparison on this page. If you're billing laterality, append LT or RT. If the procedure is performed bilaterally in a single session, use modifier 50.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.1
Practice expense RVU	10.29
Malpractice RVU	0.92
Total RVU	16.31
Medicare national rate	$544.77
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	$544.77
HOPD (APC 5073) Hospital outpatient department	$2,967.63
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,248.36

Common denial reasons

The recurring reasons claims for CPT 27603 get rejected.

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

Upcoding flag: payer challenges depth, arguing the lesion was superficial and should have been billed under a lower-complexity I&D code
Missing laterality modifier when payer contract or policy requires LT or RT for unilateral lower-extremity procedures
Global period conflict: post-op E/M billed without modifier 24 or 25, triggering automatic bundling denial
Insufficient documentation: operative note lacks depth description or characterization of evacuated material, leaving medical necessity unsupported
ICD-10 mismatch: diagnosis code reflecting only superficial abscess or minor contusion does not support a deep surgical drainage procedure

Frequently asked questions

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

01What separates 27603 from a superficial I&D code like 10061?

Depth of the collection. 27603 is for deep abscesses or hematomas in the leg or ankle — below the fascia or deep subcutaneous tissue. 10061 covers complicated or multiple superficial skin abscesses. If your operative note doesn't explicitly document the depth of dissection, expect a challenge on which code applies.

02Do I need a laterality modifier for 27603?

Yes for most payers. Append LT or RT to specify the operative leg. If you're draining bilateral deep abscesses in the same session — uncommon but possible — use modifier 50 and confirm your payer processes bilateral surgical codes correctly, as some require two line items instead.

03What modifier applies if I make the decision to drain in the same visit and then proceed immediately?

Use modifier 57 on the E/M code, not on 27603. Since 27603 has a 90-day global, modifier 57 signals that the E/M represented a decision for a major surgical procedure, separating it from the pre-op global work. Don't use modifier 25 here — 25 applies to minor procedures with 0- or 10-day globals.

04If the patient returns to the OR for re-drainage of the same site during the 90-day global, how do I bill?

Use modifier 78 on 27603 for the return trip. Modifier 78 = unplanned return to the OR for a procedure related to the original surgery during the global period. Reimbursement is reduced to the intraoperative component only. If the return procedure is for an unrelated problem, use modifier 79 instead.

05Can 27603 be billed with a wound irrigation or debridement code on the same day?

Bundling depends on NCCI edits in effect at the time of service. Generally, separate debridement or irrigation performed as part of the I&D is not additionally billable — it's included in the surgical work of 27603. If a distinct debridement of a separate anatomic site was performed, modifier 59 or XS may unbundle it, but document the distinct service clearly.

06Does site of service affect how 27603 is paid?

Yes, significantly. HOPD and ASC payments differ from the non-facility rate. See the site-of-service comparison table on this page for the current 2026 figures. Performing this procedure in a lower-cost setting can affect your facility's reimbursement while your professional fee is calculated separately.

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 depth of dissection, anatomic site, volume and character of the evacuated collection, irrigation detail, and wound closure method directly from your operative dictation. This prevents the most common audit flag for 27603 — an operative note that documents an incision but fails to confirm the deep tissue plane required to distinguish this code from a superficial I&D.

See how Mira captures CPT 27603 documentation