Secondary repair of the Achilles tendon, performed when the tendon has ruptured or failed due to an underlying condition, with or without graft augmentation.

Verified May 8, 2026 · 5 sources ↓

Medicare: $676.03
Total RVUs: 20.24
Global, days: 90
Region: Foot & ankle

Drawn from CMSMedicare.govMdclarityAAPCNIH

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify that this is a secondary (not primary) repair — document the underlying condition causing the rupture (e.g., calcaneal spur, chronic tendinopathy, prior surgery).
Describe the surgical technique: extent of debridement, method of tendon re-approximation, suture type, and whether graft augmentation was used and graft source.
Document the laterality (left vs. right) explicitly in both the operative note header and the body of the report.
Record intraoperative findings including tendon quality, gap size, degree of degeneration, and any associated pathology addressed.
If a concomitant procedure was performed (e.g., calcaneal exostectomy), document each procedure as a distinct surgical step with its own findings and rationale.
Pre-operative imaging (MRI or ultrasound) confirming tendon pathology and ruling out primary acute rupture should be referenced in the note.

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 52 Reduced services 59 Distinct service 62 Co-surgeons 73 Discontinued pre-anesthesia 74 Discontinued post-anesthesia 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 27654 covers secondary Achilles tendon repair — meaning the tendon has ruptured in the setting of, or as a consequence of, a pre-existing condition such as a calcaneal spur, tendinopathy, or prior incomplete healing. This distinguishes it from 27652, which is primary repair of an acute, otherwise healthy tendon. The procedure involves surgical re-approximation of the tendon ends, which may include graft augmentation when native tissue is insufficient for a durable repair.

The 90-day global period means all routine follow-up through day 90 — wound checks, cast or boot management, suture removal — is bundled. Anything outside routine post-op management requires modifier 24 (E/M unrelated to surgery) or 79 (unrelated procedure in the global). If the patient returns to the OR for a complication related to the original repair, bill modifier 78.

This code appears in the leg and ankle repair/reconstruction section and is billed by orthopedic surgeons and podiatrists. Side-specific modifiers (LT, RT) are expected on all unilateral extremity procedures. When additional distinct procedures are performed at the same session — such as calcaneal exostectomy for a pump bump — append modifier 59 or XS to the secondary code to bypass NCCI bundling edits.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.27
Practice expense RVU	8.35
Malpractice RVU	1.62
Total RVU	20.24
Medicare national rate	$676.03
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	$676.03
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,714.43

Common denial reasons

The recurring reasons claims for CPT 27654 get rejected.

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

Billed as 27654 when operative note describes an acute rupture in a healthy tendon — payer downcodes to 27652 (primary repair).
Missing or ambiguous laterality — no LT or RT modifier causes claim rejection or pends for manual review.
Concomitant procedures (e.g., calcaneal exostectomy, plantar fasciectomy) denied as bundled without modifier 59 or XS to establish distinct procedural service.
Insufficient documentation of secondary etiology — operative note lacks mention of underlying condition that caused the tendon failure, making the secondary code undefendable on audit.
Claims for related E/M visits or minor procedures submitted during the 90-day global period without modifier 24 or 79, triggering automatic bundling denial.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What is the difference between CPT 27652 and 27654?

27652 is primary repair — an acute rupture in a tendon without significant pre-existing disease. 27654 is secondary repair, used when the rupture occurs in the context of an underlying condition (chronic tendinopathy, calcaneal spur, prior surgery) or when the repair involves graft augmentation due to tissue deficiency. The distinction must be supported in the operative note; payers audit for it.

02Does 27654 include graft harvest?

The code descriptor covers repair with or without graft. Graft use does not automatically warrant a separate code, but document the graft source (autograft, allograft, synthetic) and rationale. If graft harvest is a significant separate surgical step, modifier 22 with supporting documentation may be appropriate for an unusually complex case.

03Can I bill 27654 with a calcaneal exostectomy on the same day?

Yes, but append modifier 59 or XS to the exostectomy code (e.g., 28119) to identify it as a distinct procedural service. Without the modifier, NCCI edits will bundle the additional procedure. Make sure the operative note documents each procedure as a separate surgical step with its own findings.

04What modifiers are required for bilateral Achilles repair?

Bilateral Achilles repair is rare but coded with modifier 50 if both sides are repaired in the same session. Alternatively, bill two line items with LT and RT. Confirm your payer's preference — some commercial payers reject the 50 modifier and require separate LT/RT lines.

05How does the 90-day global period affect post-op billing?

All routine follow-up through day 90 is bundled — wound checks, immobilization management, suture/staple removal, and routine cast changes. If a patient develops an unrelated condition requiring an E/M visit, append modifier 24. If the patient returns to the OR for a complication related to the original repair, use modifier 78. An unrelated OR procedure in the global uses modifier 79.

06Is Tenex or ultrasonic debridement billable instead of or alongside 27654?

Tenex and similar ultrasonic tendon debridement technologies remain investigational per most payer policies as of 2026 and are not separately reimbursable. Coding a 'similar' open repair code when the procedure was minimally invasive ultrasonic debridement is not appropriate. Verify coverage before scheduling.

Sources & references

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

01CMS Physician Fee Schedule 2026
02
medicare.gov
https://www.medicare.gov/procedure-price-lookup/cost/27654
03
mdclarity.com
https://www.mdclarity.com/cpt-code/27654
04
aapc.com
https://www.aapc.com/codes/cpt-codes/27654
05
vsac.nlm.nih.gov
https://vsac.nlm.nih.gov/context/cs/codesystem/CPT/version/2021/code/27654/info

Mira AI Scribe

Mira's AI scribe captures the secondary repair designation, underlying causative pathology, tendon gap size, graft use and source, and any concomitant procedures from dictation. This ensures the operative note clearly distinguishes 27654 from primary repair (27652) — the single most common audit flag on Achilles repair claims — and supports modifier 59 or XS if additional ankle or heel procedures are billed the same day.

See how Mira captures CPT 27654 documentation