Incision and drainage of an infected bursa in the lower leg or ankle region

Verified May 8, 2026 · 5 sources ↓

Medicare: $477.63
Work RVU: 4.48
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCFindacodeEmedny

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify the exact bursa location (e.g., retrocalcaneal, pretibial, anterior ankle) — not just 'lower leg bursa'
Document infectious etiology: clinical findings, culture results if available, or prior antibiotic course
Describe the surgical approach: incision size, depth of dissection, volume and character of fluid drained
Note irrigation technique and any wound packing, drain placement, or closure method
Record pre-procedure imaging or aspiration results if performed to confirm diagnosis
Confirm that local anesthesia administration is not billed as a separate injection code

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 52 Reduced services 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 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 5 cited references ↓

CPT 27604 describes surgical incision and drainage of an infected bursa located in the lower leg (tibia/fibula region) or ankle. The procedure addresses bursitis complicated by infection — the surgeon opens the bursa, evacuates purulent or infected fluid, and irrigates the space. This is a deeper, more involved procedure than a simple aspiration or superficial I&D, and it carries a 90-day global period reflecting the post-operative management required.

The 90-day global covers the day-before preoperative visit, the operative session, and all routine follow-up care through day 90. Any visit during the global period for a distinct, unrelated condition requires modifier 24 (E/M) or modifier 25 (same-day E/M before the procedure). Staged or related procedures in the global window need modifier 78; unrelated surgical returns need modifier 79.

Locally administered anesthesia for the procedure is not separately billable — NCCI policy explicitly prohibits reporting injection codes solely to document local anesthesia administered to facilitate another procedure. Document the bursa location precisely (e.g., retrocalcaneal, pretibial, anterior ankle) and confirm the infectious etiology with supporting ICD-10 diagnosis coding to avoid medical necessity denials.

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 (4.48) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (14.3) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	4.48
Practice expense RVU	9
Malpractice RVU	0.82
Total RVU	14.3
Medicare national rate	$477.63
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	$477.63
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 27604 get rejected.

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

Medical necessity denied: ICD-10 diagnosis reflects non-infected bursitis (use M71.x for infected bursa, not simple bursitis codes)
Upcoding flag when billed for a superficial aspiration — document depth of dissection to justify surgical I&D over aspiration codes
Global period conflict: follow-up visits billed without modifier 24 or 25 during the 90-day window are automatically denied
Incorrect site-of-service pairing: facility billing inconsistency between HOPD and ASC claim lines triggers edits
Missing operative report or inadequate documentation of infectious nature of the bursal fluid

Frequently asked questions

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

01Can I bill 27604 for a simple needle aspiration of a lower leg bursa?

No. 27604 is a surgical incision and drainage, not an aspiration. Needle aspiration of a bursa belongs in the 20600–20611 arthrocentesis family. Using 27604 for a needle-only procedure is a misrepresentation and an audit risk.

02What ICD-10 codes support medical necessity for 27604?

Infected bursa codes under M71.1x (other infective bursitis, coded to site) are the primary drivers. Unspecified or non-infectious bursitis codes alone will not support the infected-bursa indication and will likely trigger a medical necessity denial.

03Is local anesthesia billed separately when performing 27604?

No. NCCI policy prohibits separately reporting local anesthetic injection codes when the injection is solely to facilitate another procedure. The local anesthesia is included in 27604.

04If I need to return the patient to the OR for re-drainage of the same infected bursa during the 90-day global, how do I bill?

Use modifier 78 — unplanned return to the OR for a complication or related procedure during the global period. Do not use modifier 79, which is reserved for procedures unrelated to the original surgery.

05Can 27604 be billed bilaterally?

Bilateral lower-leg bursa drainage is uncommon but codeable. In a physician fee schedule context, append modifier 50 on a single claim line. In an ASC, report two lines with modifiers LT and RT. Reimbursement is typically capped at 150% of the single-procedure rate.

06What is the global period for 27604 and what does it include?

27604 carries a 90-day global period. It covers the day-before preoperative visit, the operative session, and all routine postoperative care through day 90 — including dressing changes, stitch removal, and standard follow-up visits related to the procedure.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the bursa location by name, the character and volume of fluid evacuated, incision depth, irrigation details, and wound management from your dictation — along with the infectious clinical indicators that support medical necessity. That prevents the most common denial pattern for 27604: a vague operative note that can't distinguish surgical I&D of an infected bursa from a routine aspiration.

See how Mira captures CPT 27604 documentation