Surgical excision of a lesion — such as a ganglion cyst or other abnormal mass — from a tendon sheath or joint capsule in the leg and/or ankle.

Verified May 8, 2026 · 9 sources ↓

Medicare: $567.15
Work RVU: 4.82
Global, days: 90
Region: Foot & ankle

Drawn from CMSMedicare.govMdclarityAAPCCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 9 cited references ↓

Specify the exact tendon sheath or capsule involved (e.g., tibialis posterior, peroneal, Achilles) — 'tendon sheath in ankle' alone is insufficient.
Document the lesion type, size, and character (ganglion cyst, fibrous nodule, calcific deposit, etc.).
Record the surgical approach and confirm the lesion was excised in its entirety, not debrided or drained.
Include preoperative diagnosis with supporting clinical findings (pain, palpable mass, imaging correlation) to justify medical necessity.
Note laterality (left vs. right leg/ankle) in both the operative report and the procedure order.
If a concurrent procedure is billed, document that the work was distinct, performed in a separate tendon or anatomic location, and not merely incidental to 27630.

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 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 9 cited references ↓

CPT 27630 covers open excision of a lesion arising from a tendon sheath or capsule in the leg and ankle region. Common targets include ganglion cysts, fibrous nodules, and calcific deposits associated with tendons such as the Achilles, tibialis posterior, and peroneal tendons. The code applies regardless of which specific tendon sheath is involved, as long as the anatomic site is the leg or ankle.

27630 carries a 90-day global period. All routine follow-up through day 90 — wound checks, dressing changes, suture removal — is bundled. If a separate E/M is billed same-day or within the global for a new or unrelated problem, modifier 24 or 25 is required. AAPC forum discussions confirm that 27680 (tenolysis) and 27630 are considered included procedures when performed together, so separate billing of both requires strong documentation of distinct work and an appropriate modifier.

Site of service matters here. The HOPD rate is nearly double the ASC rate. Physicians performing this at an ASC should weigh that differential when advising patients or negotiating facility agreements. When the procedure is performed on one extremity, append LT or RT to identify laterality — bilateral billing uses modifier 50 for professional claims and separate LT/RT lines for ASC claims, per CMS NCCI Chapter 4 guidance.

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 (4.82) 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	4.82
Practice expense RVU	11.44
Malpractice RVU	0.72
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 27630 get rejected.

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

Missing or vague laterality on the claim — payers reject unspecified side on a unilateral procedure.
Bundling denial when 27680 (tenolysis) is billed same-day without a modifier and documentation of separate, distinct work.
Medical necessity denial when the operative note lacks supporting imaging or prior conservative treatment history.
Modifier 59 or XS absent when billing 27630 alongside a concurrent foot or ankle procedure subject to NCCI PTP edits.
Global period violation — routine post-op visits billed within 90 days without modifier 24 for an unrelated problem.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 9 cited references ↓

01Does 27630 cover Achilles tendon lesion excision?

Yes. The Achilles tendon sheath is in the leg and ankle region. Document the specific tendon and lesion type — calcific Achilles tendonitis excisions have been confirmed appropriate for 27630 by AAPC orthopedic coding guidance.

02Can I bill 27630 and 27680 together for the same tendon?

Generally no. AAOS coding guidance indicates 27680 (tenolysis) is included when performed in the same field as 27630. Billing both requires documentation that the tenolysis was performed on a distinctly separate tendon and a modifier 59 or XS to bypass the edit.

03What is the global period for 27630?

90 days. All routine post-op care from the day before surgery through day 90 is bundled. Bill modifier 24 on an E/M or modifier 79 on a procedure only if the visit or service is unrelated to the original surgery.

04How do I bill 27630 for a bilateral procedure?

For professional claims, append modifier 50. For ASC claims, follow CMS NCCI guidance and bill two lines — one with modifier LT and one with modifier RT, each with one unit of service.

05Can 27630 be billed with a same-day E/M for pre-surgical decision-making?

Yes, if the decision for surgery was made at that visit and it's the same day as the procedure. Append modifier 57 to the E/M to indicate the visit was the decision-making encounter for a major procedure (90-day global).

06Is 27630 appropriate for a tibialis posterior synovectomy performed alongside a triple arthrodesis?

Potentially yes, but it depends on payer edits. AAPC forum discussions identify this as a gray area — document that the synovectomy/decompression of the tendon sheath was a distinct, separately necessary procedure from the arthrodesis, and append modifier 59 or XS.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the tendon sheath name, lesion type and size, surgical approach, and confirmation of complete excision directly from the surgeon's dictation. It also flags laterality and any concurrent procedures performed at the same site. This prevents the two most common 27630 audit triggers: a vague operative note that says 'ankle tendon lesion removed' without specifying anatomy, and a bundling denial from an undocumented second procedure billed the same day.

See how Mira captures CPT 27630 documentation