Radical resection of a tumor arising in the talus or calcaneus, involving wide-margin excision of the lesion and surrounding bone tissue.

Verified May 8, 2026 · 6 sources ↓

Medicare: $907.17
Total RVUs: 27.16
Global, days: 90
Region: Foot & ankle

Drawn from CMSMdclarityFastrvuAAPCGenhealth

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Pre-operative imaging (MRI and/or CT) confirming tumor location within talus or calcaneus, with size and margin assessment
Pathology or biopsy report establishing diagnosis (malignant, aggressive benign, or osteomyelitis) prior to or at time of surgery
Operative note specifying the bone(s) resected, margin width achieved, and whether talus, calcaneus, or both were involved
Documentation of reconstruction method if performed — bone graft type, implant used, or planned staged reconstruction
Indication for radical versus partial excision, distinguishing this procedure from 28120 partial excision codes
Final pathology report confirming margin status and histologic diagnosis for medical necessity support

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 58 Staged or related 59 Distinct service 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27647 covers radical resection of a tumor from the talus or calcaneus — the two primary weight-bearing bones of the hindfoot. The procedure requires excision of the lesion with wide margins of surrounding bone, distinguishing it from partial excision codes such as 28120 (saucerization/sequestrectomy of talus or calcaneus). It is indicated for malignant primary bone tumors, aggressive benign lesions, and severe chronic osteomyelitis unresponsive to less invasive treatment. Reconstruction with bone graft or implant may follow resection and is coded separately.

The 90-day global period covers the operative day, any day-before pre-op visit, and all routine post-op management through day 90. Staged reconstruction, hardware complications, or unrelated foot pathology treated in the same window all require modifier documentation to avoid global period denials. Given the oncologic context, multidisciplinary coordination with orthopedic oncology, medical oncology, or radiation oncology is common — but their services bill independently.

Site-of-service matters here. The gap between HOPD and ASC facility payments is substantial (see the Site of Service comparison on this page). Most radical hindfoot tumor resections requiring intraoperative frozen sections or complex reconstruction are performed in a hospital OR, which aligns with the higher HOPD facility rate. Document setting, anesthesia type, and any intraoperative pathology submission in the operative note.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	19.75
Practice expense RVU	5.73
Malpractice RVU	1.68
Total RVU	27.16
Medicare national rate	$907.17
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	$907.17
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI G2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 27647 get rejected.

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

Miscoding to partial excision code 28120 — payers downcode when operative notes describe limited bone removal without wide-margin language
Diagnosis-procedure mismatch: benign lesion ICD-10 code submitted without documentation supporting radical rather than simple excision
Global period denial when post-op visits or additional procedures lack modifiers 24, 79, or 78 to indicate they fall outside routine post-op care
Missing or delayed pathology report at time of claim submission, triggering medical necessity review and hold
Laterality absent — claims for unilateral procedures without LT or RT modifier rejected by payers requiring side designation

Frequently asked questions

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

01What is the difference between CPT 27647 and CPT 28120?

28120 covers partial excision techniques — saucerization, sequestrectomy, craterization — of the talus or calcaneus, typically for osteomyelitis debridement. 27647 is radical resection with wide margins, used for primary bone tumors or aggressive lesions requiring oncologic excision. The operative note must explicitly support wide-margin intent to defend 27647 against a downcode to 28120.

02Does CPT 27647 carry a global period?

Yes — 90-day global. The day-before pre-op visit, the operative day, and all routine post-op care through day 90 are included. Staged reconstruction, treatment of a new problem, or an unplanned return to the OR for a related complication all require modifier 58, 79, or 78 respectively to bill separately.

03Which modifier is correct when the patient returns to the OR for wound dehiscence after 27647?

Use modifier 78 — unplanned return to the operating room for a related procedure during the global period. Modifier 79 is for an unrelated procedure in the same global window. Inverting these is an audit risk and a common coder error.

04Can reconstruction after radical resection be billed separately?

Yes, if reconstruction involves a separately identifiable service such as bone grafting or implant placement, those codes may be reported with modifier 51 or 59 depending on NCCI bundling status. Verify against the NCCI edits before billing — some graft harvest codes are bundled into the primary resection.

05Is 27647 ever performed bilaterally?

Bilateral presentation of talus or calcaneus tumors is rare, but if performed, append modifier 50 and report with both LT and RT designations per payer instructions. Most commercial payers reduce the second-side payment by 50%. Always verify bilateral policy with the specific payer before submitting.

06What ICD-10 codes support medical necessity for 27647?

Primary malignant bone tumor of the ankle and foot (C40.3x), benign bone tumor of ankle and foot (D16.3x), and osteomyelitis of the ankle and foot (M86.x7x) are the principal diagnosis categories. Aggressive benign lesions like giant cell tumor require additional documentation explaining why radical rather than intralesional excision was necessary.

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(s) resected (talus, calcaneus, or both), margin width documented by the surgeon, intraoperative findings, reconstruction technique, and the clinical indication driving radical versus partial excision. This prevents the most common audit flag for 27647 — an operative note that describes the tumor removal without explicitly documenting wide-margin intent, which gives payers grounds to downcode to 28120.

See how Mira captures CPT 27647 documentation