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

Verified May 8, 2026 · 5 sources ↓

Medicare: $344.03
Work RVU: 4.61
Global, days: 90
Region: Foot & ankle

Drawn from CMSNIH

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Identify the specific tendon(s) repaired by name (e.g., tibialis anterior, extensor hallucis longus, extensor digitorum longus)
Document the anatomic level of injury and repair — confirm the site is in the leg, not the foot or ankle, to support 27664 over alternative codes
State that repair was primary and performed without graft material
Record mechanism of injury (laceration, rupture, avulsion) and preoperative functional deficit to support medical necessity
Note laterality (left vs. right leg) for modifier assignment
Describe the surgical approach, tissue quality, and suture technique used — vague operative notes are an audit flag

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 59 Distinct service 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 27664 covers primary repair of an extensor tendon in the leg — the tendons responsible for dorsiflexion and toe extension — when the repair is accomplished without a graft. The code is billed per tendon, so if multiple extensor tendons are repaired in the same operative session, each tendon repaired is a separately reportable unit. The 90-day global period means routine post-op visits, wound checks, and cast or splint management related to this repair are bundled through day 90; anything unrelated to the tendon repair in that window requires modifier 24.

The distinction between "leg" and "ankle/foot" anatomy matters for code selection. The extensor tendons (tibialis anterior, extensor hallucis longus, extensor digitorum longus) run from the anterior compartment of the leg distally. Where the repair is performed along that course determines whether 27664 or a foot/ankle-specific code applies — document the anatomic level of the laceration or tear explicitly. Payers audit operative notes for vague anatomic references when adjacent codes are in play.

Casting, splinting, and strapping applied at the same operative encounter are not separately billable per NCCI policy when any musculoskeletal system procedure from the 20000–29999 range is also reported for the same anatomic area. Do not append a strapping code to 27664 for the same-session post-repair immobilization.

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 (4.61) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (10.3) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	4.61
Practice expense RVU	4.98
Malpractice RVU	0.71
Total RVU	10.3
Medicare national rate	$344.03
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	$344.03
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 27664 get rejected.

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

Anatomic ambiguity — operative note does not clearly place the repair in the leg vs. foot/ankle, triggering a code mismatch denial
Unbundling of same-session casting or strapping, which NCCI bundles into the global musculoskeletal procedure
Missing graft documentation — if graft material was used but the note is unclear, payers may deny for incomplete documentation or mismatched code
Bilateral billing without modifier 50 or separate LT/RT modifiers when both legs are treated in the same session
Lack of medical necessity documentation when conservative treatment history is absent from the record

Frequently asked questions

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

01Can I bill 27664 more than once if I repair two extensor tendons in the same session?

Yes. The code is defined per tendon. Bill 27664 for each tendon repaired, list the highest-RVU procedure first, and append modifier 51 to the additional units. Document each tendon by name in the operative report.

02What is the global period for 27664?

90 days. The global covers the surgery, the day-before preoperative visit, and all routine post-op care through day 90. Use modifier 24 for unrelated E/M services and modifier 79 for an unrelated procedure during the global window.

03Can I bill a splint or cast separately after performing 27664?

No. Per NCCI policy, casting and strapping codes are bundled into musculoskeletal system procedures (20000–29999) when applied to the same anatomic area at the same encounter. Do not add a strapping code to 27664 for post-repair immobilization.

04What is the difference between 27664 and a foot extensor tendon repair code?

27664 applies when the repair site is in the leg. Extensor tendon repairs in the foot use separate codes from the foot section (28200–28299 range). Document the anatomic level of the laceration or rupture precisely — an audit or denial often hinges on this distinction.

05Does 27664 cover repairs done with a tendon graft?

No. 27664 is primary repair without graft. If graft material is used to reinforce or bridge the repair, a different code applies. Document clearly whether the repair was primary and graft-free, since the absence of that language can trigger a documentation-based denial.

06What modifier do I use when performing 27664 on both legs in the same session?

Append modifier 50 for a bilateral procedure reported on a single line, or use LT and RT on separate lines per payer preference. Confirm your payer's bilateral billing requirement before submitting — some commercial payers require separate line items.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the tendon name, anatomic level of injury, confirmation that no graft was used, and laterality directly from dictation — preventing the operative note vagueness that drives anatomic-site denials and code-mismatch flags. It also flags when multiple tendons are repaired so each can be billed as a separate unit under 27664.

See how Mira captures CPT 27664 documentation