Percutaneous tenotomy of the Achilles tendon performed through a needle or small stab incision without open exposure of the tendon.

Verified May 8, 2026 · 6 sources ↓

Medicare: $254.85
Total RVUs: 7.63
Global, days: 10
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 6 cited references ↓

Confirm percutaneous approach — document that no open incision or tendon exposure was performed
Specify the technique used (needle tenotomy, stab incision, triple hemisection with incision levels and locations)
Document the indication — equinus contracture, clubfoot, spasticity, or other — with supporting clinical findings
Record the laterality (left, right, or bilateral) explicitly in the operative note
If cast was applied same-session, document it as a separate paragraph to support separate billing if applicable
Note the patient's age and any underlying condition (e.g., cerebral palsy, idiopathic clubfoot) to support medical necessity

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 59 Distinct service LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

27606 covers a percutaneous Achilles tenotomy — a needle-based or mini-stab incision technique that releases the tendon without formal open dissection. It carries a 10-day global period, meaning routine follow-up within that window is bundled. The procedure is most commonly performed for equinus contracture correction, including clubfoot management in pediatric patients under the Ponseti method, where a cast applied at the same session (29450) may or may not be separately billable depending on NCCI edits and payer policy.

Distinguish 27606 from 27685 (open lengthening or release of the Achilles/leg tendon). If the surgeon performs a percutaneous triple hemisection — multiple stab incisions at different levels — document each incision level explicitly. Payers differ on whether that constitutes the same service or a more complex procedure warranting 27685 or modifier 22. The operative note must support whichever code is selected.

Site of service matters here. The HOPD and ASC facility payments differ substantially; see the Site of Service comparison table. Orthopedic surgery and podiatry are the dominant billing specialties per CMS Physician Fee Schedule 2026 utilization data.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	4.08
Practice expense RVU	2.9
Malpractice RVU	0.65
Total RVU	7.63
Medicare national rate	$254.85
Global period	10 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	$254.85
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 27606 get rejected.

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

Upcoding to 27685 when documentation only supports a percutaneous technique — audit teams flag open vs. percutaneous discrepancies
Missing or ambiguous laterality when LT/RT modifier is required by the payer
Bundling of same-session cast application (29450) without verifying NCCI edit status or applying modifier 59/XS
Lack of documented medical necessity when diagnosis code does not clearly support Achilles release
Bilateral procedures billed without modifier 50 or separate LT/RT line items per payer preference

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What is the difference between 27606 and 27685?

27606 is percutaneous — no open exposure of the tendon. 27685 covers open lengthening or release. If the surgeon makes a formal incision and directly visualizes the tendon, 27685 is correct. Percutaneous triple hemisection is a gray zone; document incision count and depth carefully, and some coders argue modifier 22 on 27606 rather than jumping to 27685.

02Can I bill 29450 (clubfoot cast) on the same day as 27606?

This is an active NCCI question. An AAPC forum discussion confirms an NCCI edit exists between these codes. Check current NCCI PTP edits — if an edit is present without a modifier indicator of '1,' the cast is bundled. If the indicator allows override, append modifier 59 or XS with documentation showing the cast is a distinct service.

03What global period applies to 27606?

10-day global. Routine post-op visits, dressings, and cast checks within 10 days are bundled. Anything unrelated in that window needs modifier 24 on an E/M. An unrelated procedure needs modifier 79.

04How do I bill bilateral Achilles tenotomies performed in the same session?

Bill 27606 twice — one unit with modifier LT, one with RT — or a single line with modifier 50, depending on payer preference. Medicare prefers LT/RT on separate lines. Verify with each commercial payer before submission; some require modifier 50 on a single line.

05Is modifier 22 ever appropriate for 27606?

Yes, if the procedure was substantially more complex than typical — for example, a percutaneous triple hemisection requiring multiple stab incisions at distinct levels in a patient with severe spastic equinus. Document the extra work explicitly: number of passes, levels treated, total operative time, and why complexity exceeded the standard tenotomy. Without that documentation, modifier 22 will be denied.

06Which diagnosis codes most commonly support 27606?

Equinus deformity (M21.37x), congenital clubfoot/talipes equinovarus (Q66.0x), and spastic equinus secondary to cerebral palsy or other neurologic conditions are the most frequently accepted diagnoses. The ICD-10 code must specify laterality where required.

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 operative approach (percutaneous vs. open), number and location of incision levels, laterality, the primary indication, and whether a cast was applied at the conclusion of the case. That documentation prevents the two most common audit flags for 27606: an operative note that doesn't distinguish percutaneous from open technique, and a missing or contradictory laterality statement that triggers a claim edit.

See how Mira captures CPT 27606 documentation