Soft tissue repair · Foot & ankle
Primary open or percutaneous repair of a ruptured Achilles tendon using a graft, with graft harvesting included in the code.
Verified May 8, 2026 · 8 sources ↓
- Medicare
- $616.58
- Total RVUs
- 18.46
- 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 8 cited references ↓
- Specify repair timing as primary (acute rupture) — distinguish clearly from secondary/revision repair
- Identify graft type by name (e.g., plantaris autograft, allograft tendon strip) and confirm it is a structural graft, not PRP or biologic augmentation alone
- Document surgical approach: open vs. percutaneous, incision location, tendon exposure
- State that graft harvesting was performed during the same operative session if autograft was used
- Confirm diagnosis as acute Achilles tendon rupture with ICD-10 code (e.g., S86.011A for initial encounter)
- Document any fixation technique (suture anchors, transosseous tunnels) used to secure graft — hardware is bundled and should not be billed separately to Medicare
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 8 cited references ↓
27652 covers a primary repair of an Achilles tendon rupture — open or percutaneous — where the surgeon augments the repair with a graft. Graft procurement is bundled; do not separately report harvesting. Use this code instead of 27650 when the operative note clearly documents graft use. 27654 is the correct code when the repair is secondary (revision/delayed).
The distinction between 27650, 27652, and 27654 is the most common coding error in this family. 27652 requires two elements: primary timing and graft use. If your surgeon used only suture repair without a structural graft, 27650 is correct. If the repair is secondary, 27654 applies regardless of whether a graft was used. PRP matrix alone does not qualify as a graft for 27652 purposes — payers consistently deny that upgrade.
The 90-day global period covers the surgery date, the day-before visit, and all routine post-op management through day 90. Separate billing for wound checks, suture removal, or cast changes in that window requires modifier 24 (unrelated E/M) or 58 (staged procedure). Fixation hardware such as suture anchors is included and not separately billable to Medicare; HCPCS C1713 applies in the facility setting for implant cost reporting but does not generate a separate physician fee.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 10.51 |
| Practice expense RVU | 6.56 |
| Malpractice RVU | 1.39 |
| Total RVU | 18.46 |
| Medicare national rate | $616.58 |
| 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 | $616.58 |
HOPD (APC 5114) Hospital outpatient department | $7,413.38 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $4,914.65 |
Common denial reasons
The recurring reasons claims for CPT 27652 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Upgrading 27650 to 27652 based on PRP or biologic matrix use — payers do not accept PRP as a qualifying graft
- Billing 27652 when the repair is secondary/revision — correct code is 27654
- Separately reporting graft harvesting alongside 27652 — harvesting is explicitly included in the code descriptor
- Missing or vague graft documentation — operative notes that reference 'flap augmentation' or 'biologic reinforcement' without naming a structural graft trigger medical review and downcoding to 27650
- Global period violations — billing routine post-op E/M visits without modifier 24 during the 90-day window
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 8 cited references ↓
01What is the difference between 27650, 27652, and 27654?
02Can I bill 27652 if the surgeon used PRP during the repair?
03Is graft harvesting separately billable with 27652?
04Can suture anchors or screws used during the repair be billed separately?
05What modifier is needed to bill a staged procedure during the 90-day global?
06Is 27652 billable bilaterally?
07Does the site of service affect reimbursement for 27652?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02CMS 2026 OPPS Final Rule – www.cms.gov
- 03CMS 2026 ASC Final Rule – www.cms.gov
- 04arthrex.comhttps://www.arthrex.com/resources/DOC1-002084-en-US/achilles-soft-tissue-implants-2026-coding-and-reimbursement-guidelines
- 05aapc.comhttps://www.aapc.com/codes/coding-newsletters/my-orthopedic-coding-alert/reader-questions-report-these-codes-for-ruptured-achilles-tendon-repair-169842-article
- 06aapc.comhttps://www.aapc.com/codes/cpt-codes/27652
- 07cms.govhttps://www.cms.gov/files/document/medicare-ncci-policy-manual-2024-chapter-4.pdf
- 08cgsmedicare.comhttps://www.cgsmedicare.com/medicare_dynamic/j15/partb/ptpb/ptp.aspx
Mira AI Scribe
Mira's AI scribe captures the graft type and source, repair approach (open vs. percutaneous), and the acute/primary nature of the rupture directly from dictation. That documentation chain prevents the two most common downcodes: payers auditing for graft specificity and reviewers reclassifying primary repairs as secondary when timing language is ambiguous.
See how Mira captures CPT 27652 documentation