Secondary repair of one or more flexor tendons of the leg, performed after a prior repair attempt, with or without tendon graft placement.

Verified May 8, 2026 · 5 sources ↓

Medicare: $446.57
Total RVUs: 13.37
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCFindacodeMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Explicit notation that this is a secondary (revision) repair following prior tendon surgery, with prior operative history referenced
Identification of the specific flexor tendon(s) repaired by anatomic name — e.g., flexor hallucis longus, flexor digitorum longus
Description of intraoperative findings: scar tissue, adhesion extent, tendon gap size, tissue quality
Statement of repair technique: end-to-end suture, tendon graft harvest and placement, or other reconstruction method
Laterality clearly documented in both the operative note and on the claim (LT or RT)
If modifier 22 is billed, operative note must quantify increased time and complexity compared to a standard repair

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 27659 covers secondary (revision) surgical repair of a flexor tendon in the leg — tibia/fibula region through the ankle — performed on a patient who has had a prior tendon repair. The procedure may include graft augmentation when native tendon tissue is insufficient. Because this is a secondary repair, the operative complexity is typically greater than a primary repair: scar tissue, adhesions, and altered anatomy all increase surgical work. Modifier 22 is warranted when operative time and complexity significantly exceed the norm, but document it thoroughly — auditors expect a compelling narrative, not a form-field checkbox.

The 90-day global period means all routine post-op management through day 90 is bundled. Any E/M visit during that window for a new or unrelated problem needs modifier 24. A return to the OR for a related complication — tendon re-rupture, wound dehiscence — gets modifier 78. If you're repairing multiple flexor tendons in the same session, bill 27659 for the first tendon and append modifier 51 for each additional unit, unless payer policy directs otherwise. Confirm NCCI edits before adding same-session codes for adjacent procedures.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.92
Practice expense RVU	5.46
Malpractice RVU	0.99
Total RVU	13.37
Medicare national rate	$446.57
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	$446.57
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 27659 get rejected.

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

Missing documentation of prior repair — payers require proof this is a secondary procedure, not a primary repair miscoded
Laterality not specified on claim — LT/RT absent triggers edit or rejection at many MACs and commercial payers
Bundling with same-session codes that are NCCI column-2 edits without an appropriate modifier 59 or XS to bypass
Modifier 22 submitted without supporting operative note narrative explaining why complexity exceeded the standard — blanket use leads to downcoding or denial
Global period conflict — E/M billed within 90-day global without modifier 24, triggering automatic denial

Frequently asked questions

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

01What makes 27659 a secondary repair code — and how do I document that?

27659 is specifically for repair performed after a prior tendon repair attempt. The operative note must reference the prior surgery — date, procedure, and surgeon if known. Without that history, payers treat it as an undocumented primary repair and may deny or downcode.

02Can I bill 27659 more than once if I repaired two flexor tendons in the same session?

Yes. Bill 27659 for the primary tendon repair and a second unit of 27659 with modifier 51 for each additional tendon repaired. Document each tendon by name in the operative note. Some payers may limit units — verify MUE limits and payer policy before submitting multiple units.

03Do I need LT or RT on every claim for 27659?

Yes. Most MACs and commercial payers require laterality for musculoskeletal surgical codes. Missing LT or RT is a leading edit trigger. Always append the appropriate modifier — don't rely on the ICD-10 diagnosis code to carry that information.

04When does modifier 22 apply to 27659?

Use modifier 22 when the procedure required substantially greater work than typical — dense adhesions, prior hardware, failed graft requiring excision, unusually large tendon gap. The operative note must narrate the specific factors, not just check a box. Payers audit modifier 22 claims on musculoskeletal codes aggressively.

05What is the global period for 27659, and what can I still bill during it?

27659 carries a 90-day global. Routine post-op visits, dressings, and suture removal are bundled through day 90. Bill modifier 24 on an E/M for a new or unrelated condition during the global. Use modifier 78 if the patient returns to the OR for a related complication — such as re-rupture — within the global period.

06Is a tendon graft included in 27659 or separately billable?

Graft placement is included in 27659 — the code explicitly covers repair with or without graft. Do not separately bill a graft harvest code if the graft was used for this same tendon repair. Separate billing would be an unbundling violation under NCCI policy.

Sources & references

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

01CMS Physician Fee Schedule 2026
02
aapc.com
https://www.aapc.com/codes/cpt-codes/27659
03
findacode.com
https://www.findacode.com/cpt/27659-cpt-code.html
04
mdclarity.com
https://www.mdclarity.com/cpt-code/27659
05
cms.gov
https://www.cms.gov/files/document/04-chapter4-ncci-medicare-policy-manual-2025finalcleanpdf.pdf

Mira AI Scribe

Mira's AI scribe captures the tendon name, laterality, prior repair history, intraoperative findings (gap measurement, tissue quality, adhesion extent), repair technique, and graft use directly from dictation. That detail prevents the two most common denials for 27659: missing secondary-repair documentation and absent laterality — both of which reviewers flag before a human ever reads the note.

See how Mira captures CPT 27659 documentation