Primary open or percutaneous surgical repair of a completely ruptured Achilles tendon, performed without a graft.

Verified May 8, 2026 · 6 sources ↓

Medicare: $624.26
Total RVUs: 18.69
Global, days: 90
Region: Foot & ankle

Drawn from AAPCOrthobillingexpertMdclarityMedibillmdPayerprice

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm acute versus chronic rupture — primary vs. secondary repair distinction is audit-critical and drives code selection between 27650 and 27654
Specify surgical approach: open incision with tenorrhaphy, minimally invasive, or percutaneous technique — operative note must name the approach explicitly
Document that no graft was harvested or used; if graft was obtained, 27650 is not the correct code
Record laterality (right vs. left) in both the operative note and on the claim with RT or LT modifier
Note tendon condition at repair: extent of tear, tissue quality, and suture technique used (e.g., Krackow, Bunnell)
If E/M was performed the same day for the surgical decision, document medical necessity of that visit separately with modifier 57 appended to the E/M code

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 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

27650 covers primary repair of an acute Achilles tendon rupture — open or percutaneous — where the surgeon reapproximates and sutures the torn tendon ends without requiring a graft. Use this code for fresh ruptures repaired at the time of injury or shortly after. If a graft is required during the primary repair, step up to 27652. If the repair is secondary (failed prior repair, re-rupture, or delayed presentation), 27654 is the correct code instead.

27650 carries a 90-day global period. That window covers the operative session, the day-before visit, and all routine post-op care through day 90. An E/M billed the same day as surgery for the decision to operate needs modifier 57. Laterality modifiers LT or RT are standard — append them on every claim; payers flag Achilles repairs submitted without side designation.

This code sits in the moderate-complexity surgical tier. The procedure is performed almost exclusively in ASC or hospital outpatient settings. When a same-day E/M precedes the surgical decision, append modifier 57 to the E/M, not modifier 25 — modifier 25 is reserved for minor procedures with 0- or 10-day globals.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	8.98
Practice expense RVU	8.26
Malpractice RVU	1.45
Total RVU	18.69
Medicare national rate	$624.26
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	$624.26
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,682.29

Common denial reasons

The recurring reasons claims for CPT 27650 get rejected.

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

Missing laterality modifier — payers routinely reject Achilles repair claims without RT or LT
27650 billed when operative note describes a graft harvest or augmentation — should be 27652 instead
27650 billed for a secondary or delayed repair (re-rupture or failed prior repair) — correct code is 27654
Modifier 25 appended to a same-day E/M instead of modifier 57 — 25 applies to minor procedure globals (0 or 10 days), not 90-day global surgeries
Routine post-op visits billed within the 90-day global period without modifier 24 or 79 to establish unrelatedness

Frequently asked questions

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

01What is the difference between 27650, 27652, and 27654?

27650 is primary repair without a graft. 27652 is primary repair with a graft (includes graft harvest). 27654 is secondary repair — use it for re-ruptures, failed primary repairs, or significantly delayed presentations. Getting this wrong is the most common denial reason for Achilles repair claims.

02Do I need a laterality modifier on 27650?

Yes. Append RT or LT on every claim. Achilles repairs submitted without laterality are routinely flagged or denied. Modifier 50 applies only if both Achilles tendons are repaired in the same session, which is rare.

03Which modifier goes on a same-day E/M when the surgeon decides to operate?

Modifier 57, not 25. Modifier 57 signals a decision for a major surgical procedure (90-day global). Modifier 25 is for minor procedures with 0- or 10-day global periods. Appending 25 to a pre-op E/M for a 90-day global surgery will generate a denial.

04What is covered under the 90-day global period for 27650?

The day-before visit, the operative session, and all routine post-op visits, dressings, cast or splint changes, and suture removals through day 90. To bill anything unrelated during that window, use modifier 79. For a related unplanned return to the OR, use modifier 78.

05Can 27650 and 27652 be billed together on the same day?

No. They are mutually exclusive — you either used a graft or you didn't. Bill 27650 for graft-free primary repair or 27652 if a graft was required. Billing both for the same tendon on the same day will trigger an NCCI bundling edit.

06When is modifier 62 appropriate for 27650?

Modifier 62 covers co-surgery when two surgeons of different specialties each perform a distinct, necessary component of the repair and each dictates their own operative note. It is uncommon for a straightforward Achilles repair but may apply in complex trauma cases involving a vascular or plastic surgeon.

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 approach (open vs. percutaneous), confirms absence of graft use, records tendon condition and suture technique, and flags laterality from dictation — all before the note is signed. That prevents the most common 27650 denial: wrong code selection when the note actually describes a graft or a secondary repair, and missing side designation on the claim.

See how Mira captures CPT 27650 documentation