Incision into the leg or ankle bone to treat osteomyelitis or a bone abscess, including excision of infected or necrotic bone tissue.

Verified May 8, 2026 · 7 sources ↓

Medicare: $567.15
Work RVU: 8.4
Global, days: 90
Region: Foot & ankle

Drawn from CMSEmednyAAPCCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Diagnosis of osteomyelitis or bone abscess with supporting imaging (MRI, CT, or bone scan) or lab findings (elevated ESR, CRP, culture results)
Operative note naming the specific bone(s) entered (tibia, fibula, or ankle) and extent of debridement or excision performed
Description of wound management: packing, antibiotic bead placement, primary vs. delayed closure, or negative-pressure dressing
Pre-op conservative treatment history or clinical rationale for surgical intervention — required by most payers for medical necessity
Culture and pathology specimen submission documented in the operative note when tissue is sent
Laterality documented clearly (left vs. right leg/ankle) to support LT/RT modifier assignment

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 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 27607 covers an open incisional procedure on the tibia, fibula, or ankle in which the surgeon cuts into bone to drain, debride, or excise an abscess or osteomyelitic focus. The procedure requires direct visualization of the infected bone, removal of devitalized tissue, and — when indicated — placement of antibiotic-impregnated material or wound packing. It is categorically distinct from percutaneous drainage; the incision must reach bone-level pathology.

The 90-day global period governs all post-op visits, wound checks, and routine dressing changes through day 90. Subsequent procedures required to manage the same infection site — such as repeat debridement — need modifier 78 if unplanned and related. If the surgeon separately addresses a second anatomically distinct bone site during the same session, modifier 59 or XS supports billing that second procedure with documentation of distinct site.

Site-of-service matters here. The gap between HOPD and ASC facility payment is substantial; see the site-of-service comparison table rendered on this page. Confirm payer authorization for the planned setting before scheduling, particularly for Medicaid, which applies state-specific medical necessity criteria.

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 (8.4) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (16.98) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	8.4
Practice expense RVU	6.93
Malpractice RVU	1.65
Total RVU	16.98
Medicare national rate	$567.15
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	$567.15
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 27607 get rejected.

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

Medical necessity denial when pre-surgical imaging or lab evidence of osteomyelitis is absent from the record
Laterality mismatch — missing or incorrect LT/RT modifier causes automatic rejection on most payer edits
Bundling denial when a same-day incision and drainage code (e.g., 27603) is billed without modifier 59 or XS and a distinct site
Global period violation when a post-op wound debridement is billed without modifier 78 for the related return to the OR
Insufficient operative note detail — notes stating only 'bone abscess debrided' without specifying bone involved or extent of resection trigger ADR requests

Frequently asked questions

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

01Does 27607 require intraoperative culture documentation to bill?

No CPT rule mandates it, but many payers — and audit contractors — expect culture results or a documented reason cultures were not obtained when billing for osteomyelitis. Include specimen disposition in the operative note to preempt ADRs.

02Can 27607 be billed bilaterally with modifier 50?

Yes, if osteomyelitis is treated in both legs at the same session, modifier 50 applies. Bill one line with modifier 50. Reimbursement is typically capped at 150% of the single-procedure fee schedule amount. Document each side's findings separately in the operative note.

03If the patient returns to the OR two weeks later for repeat debridement of the same site, which modifier applies?

Modifier 78 — unplanned return to the OR for a procedure related to the original surgery during the global period. Do not use modifier 79, which is reserved for unrelated procedures. Document the clinical reason the return was unplanned.

04What ICD-10 diagnosis codes support medical necessity for 27607?

Primary codes are from the M86 (osteomyelitis) family — acute, subacute, and chronic forms with tibia/fibula site specificity. M86.361, M86.371, M86.161, M86.171, and their chronic counterparts are the most commonly matched. Payers expect the ICD-10 code to specify laterality and bone.

05Is 27607 ever appropriate when imaging is negative but clinical signs strongly suggest osteomyelitis?

Yes, but document the clinical basis explicitly: wound probing to bone, failed antibiotic course, or intraoperative findings. Some payers require a prior imaging attempt regardless; check individual payer LCD or medical necessity policy. A negative MRI with positive probe-to-bone finding is a defensible record if documented thoroughly.

06How does the 90-day global affect billing for wound care visits after 27607?

Routine post-op wound checks, dressing changes, and suture removal are bundled into the global period through day 90 — bill nothing separately for those. If a new, unrelated condition is addressed at a post-op visit, use modifier 24 on the E/M. If a related unplanned surgical return is needed, use modifier 78 on the procedure code.

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 specific bone involved (tibia vs. fibula vs. ankle), the extent of debridement or excision, wound management method, and specimen submission from dictation. This prevents the most common ADR trigger — operative notes that confirm an incision was made but fail to document bone-level pathology findings and what was removed — which payers use to reclassify the procedure to a lower-complexity I&D code.

See how Mira captures CPT 27607 documentation