Soft tissue repair · Foot & ankle
Open ankle arthrotomy with synovectomy and tenosynovectomy — surgical removal of the ankle joint synovial lining combined with excision of the surrounding tendon sheath tissue.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $564.14
- Total RVUs
- 16.89
- Global, days
- 90
- Region
- Foot & ankle
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 6 cited references ↓
- Operative note must name the specific approach used to access the ankle joint — vague 'standard arthrotomy' language is an audit flag.
- Explicitly document that tenosynovectomy was performed, not synovectomy alone — this is the clinical distinction between 27625 and 27626.
- Identify which tendons had their sheaths excised (e.g., peroneal, posterior tibial, flexor hallucis longus) and document the extent of tissue removed.
- Document the preoperative diagnosis with supporting imaging or prior conservative treatment failure to establish medical necessity for open synovectomy.
- Record intraoperative findings including extent and character of synovial disease (hyperplastic, fibrotic, hemosiderin-laden, etc.).
- Laterality must be specified in both the operative note and the claim — RT or LT modifier required for unilateral procedures.
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 6 cited references ↓
27626 covers an open ankle arthrotomy in which the surgeon removes both the synovial membrane lining the ankle joint and the tenosynovium surrounding adjacent tendons. This distinguishes it from 27625, which stops at synovectomy alone — if you performed tenosynovectomy through the same incision, 27626 is the correct code. The procedure is performed to address inflammatory or destructive joint disease, most commonly rheumatoid arthritis, pigmented villonodular synovitis (PVNS), or refractory synovitis unresponsive to conservative management.
The 90-day global period covers the operative session, the day-before visit, and all routine post-op management through day 90. Separate billing for routine wound checks, dressing changes, or suture removal during that window requires modifier 24 (E/M) or modifier 25 (same-day E/M) with clear documentation that the visit addressed a problem unrelated to the surgical diagnosis. New or worsening complications requiring a return to the OR in the global period use modifier 78 if related to the original procedure, or modifier 79 if unrelated.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 8.87 |
| Practice expense RVU | 6.69 |
| Malpractice RVU | 1.33 |
| Total RVU | 16.89 |
| Medicare national rate | $564.14 |
| 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 | $564.14 |
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 27626 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Upcoding flag: billing 27626 when the operative note only documents synovectomy without explicit tenosynovectomy — defaults the claim to 27625.
- Missing medical necessity: no documented failed conservative treatment or prior imaging supporting degree of synovial disease requiring open excision.
- Laterality modifier absent or mismatched between the claim and operative report.
- NCCI bundling conflict when separately billing component services already included in the open arthrotomy approach (e.g., joint exploration, loose body removal performed through the same incision).
- Global period violation: routine post-op visits billed without modifier 24 during the 90-day global window.
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What is the difference between 27625 and 27626?
02Can 27626 be billed with ankle arthroscopy codes on the same day?
03Does 27626 carry a global period, and what does that mean for post-op billing?
04When should modifier 50 be used with 27626?
05What ICD-10 diagnoses most commonly support 27626?
06Is modifier 22 ever appropriate for 27626?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01abos.orghttps://www.abos.org/wp-content/uploads/2019/12/sports-cpt-updated.pdf
- 02mdclarity.comhttps://www.mdclarity.com/cpt-code/27626
- 03cms.govhttps://www.cms.gov/files/document/2026-medicaid-ncci-chapter-1-policy-manual.pdf
- 04cms.govhttps://www.cms.gov/files/document/2026-ncci-medicaid-policy-manual.pdf
- 05aaos.orghttps://www.aaos.org/globalassets/quality-and-practice-resources/coding-and-reimbursement/resident-guide/resident-guide_global-surgical-package.pdf
- 06CMS Physician Fee Schedule 2026
Mira AI Scribe
Mira's AI scribe captures the surgeon's dictation of both the synovectomy and tenosynovectomy steps, names the specific tendons whose sheaths were excised, records the approach used, and flags laterality — preventing the most common downcode from 27626 to 27625 caused by operative notes that describe joint lining removal but omit the tenosynovectomy documentation that justifies the higher-level code.
See how Mira captures CPT 27626 documentation