Primary surgical repair of a flexor tendon in the leg, performed without a graft, billed per tendon repaired.

Verified May 8, 2026 · 8 sources ↓

Medicare: $357.06
Work RVU: 4.99
Global, days: 90
Region: Foot & ankle

Drawn from AAPCMdclarityCMSGenhealthFindacode

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Identify the specific tendon(s) repaired by name (e.g., flexor digitorum longus, flexor hallucis longus) — 'flexor tendon' alone is insufficient for multi-unit billing
Confirm the repair was performed at the leg or ankle level, not within the foot (foot-level flexor repairs bill under 28200)
State explicitly that no tendon graft was used — graft use shifts the code to 27659
Document the mechanism of injury or pathology (acute laceration, rupture) to distinguish repair from debridement-only procedures
Record the surgical approach, incision location, and suture technique used
Note laterality (left vs. right leg) to support LT/RT modifier use

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

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

CPT 27658 covers primary open repair of a flexor tendon in the leg (below the knee, above the foot) without the use of a tendon graft. The code is unit-based — each tendon repaired in the same session is billed separately under this code. Common clinical scenarios include acute flexor tendon lacerations or ruptures repaired by direct suture technique. If a graft is required, step up to 27659.

The 90-day global period means all routine follow-up, splint and cast checks, suture removal, and postoperative visits through day 90 are bundled into the surgical payment. Anything outside routine post-op care — new injuries, unrelated conditions — requires modifier 24 or 25 to bypass the global. A return to the OR for a related complication within the global uses modifier 78; an unrelated procedure in the same window uses modifier 79.

When 27658 is billed alongside 27680 (tenolysis, flexor tendon, leg), NCCI bundles 27680 as the column 2 code. If the tenolysis was a genuinely separate procedure — distinct tendon, distinct incision — append modifier 59 (or the appropriate X modifier) to 27680 and document clearly. Debridement alone for tendinitis without documented tear or laceration does not support 27658; that work flows to 27680.

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 (4.99) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (10.69) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	4.99
Practice expense RVU	4.94
Malpractice RVU	0.76
Total RVU	10.69
Medicare national rate	$357.06
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	$357.06
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 27658 get rejected.

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

Billed with 27680 without modifier 59 — NCCI bundles tenolysis into the repair code unless a distinct procedural service is documented
Tendon location ambiguous or documented within the foot — payers redirect to 28200 when operative note doesn't confirm leg/ankle level
Graft language in the operative note triggers downcoding or denial because 27658 is defined as without graft — document explicitly if graft was not used
Multiple units billed without per-tendon documentation — each additional tendon requires named identification in the operative note
Post-op visit billed without modifier 24 during the 90-day global — routine follow-up is bundled and will be denied

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01How many times can 27658 be billed on the same operative report?

Once per tendon repaired. Each distinct flexor tendon repaired in the same session bills as a separate unit of 27658. The operative note must name each tendon individually — a generic reference to 'flexor tendons' won't support multiple units on audit.

02What is the difference between 27658 and 27659?

27658 is primary flexor tendon repair without a graft. 27659 covers repairs performed with or without a graft. If any graft material was used to bridge or augment the tendon, bill 27659. If the operative note mentions graft but 27658 was submitted, expect a denial or takebacks on audit.

03Can 27658 and 27680 be billed together?

Only with modifier 59 on 27680. NCCI lists 27680 (tenolysis) as a column 2 code to 27658's column 1. If the tenolysis was performed on a separate tendon through a separate incision, append 59 to 27680 and document the distinct service clearly. Bundling without that modifier will result in denial of 27680.

04Does the repair of a flexor hallucis longus tendon in the foot use 27658?

No. If the repair is performed within the foot, use 28200. 27658 applies when the repair occurs at the ankle or leg level. The anatomical level must be explicitly stated in the operative note — payers and auditors draw this line based on your documentation.

05What global period applies to 27658, and what does it include?

27658 carries a 90-day global. That covers the day-before pre-op visit, the surgery itself, and all routine post-op care through day 90 — wound checks, splint and cast management, suture removal, and standard follow-up. Separate billing within that window for unrelated conditions requires modifier 24 on E/M services.

06When is modifier 22 appropriate for 27658?

Use modifier 22 when the repair involved substantially increased complexity — for example, heavily scarred tissue, gross contamination, or unusual tendon retraction requiring significantly more time and effort than a typical primary repair. Document the specific complicating factors in the operative note; modifier 22 without supporting narrative will be denied.

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 tendon name, anatomical level (leg vs. foot), graft status, and laterality directly from the surgeon's dictation. It flags operative notes that reference 'graft' language alongside 27658, prompting the coder to confirm 27659 isn't more appropriate. This prevents the most common denial path — mismatched code and operative report — before the claim is submitted.

See how Mira captures CPT 27658 documentation