Secondary repair of an extensor tendon in the leg, with or without graft — billed per tendon repaired.

Verified May 8, 2026 · 6 sources ↓

Medicare: $399.47
Work RVU: 5.43
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCMdclarityAbosAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm this is a secondary repair — note the prior repair procedure, date, and outcome in the operative report
Identify the specific extensor tendon(s) repaired by anatomic name (e.g., extensor digitorum longus, extensor hallucis longus, tibialis anterior)
Document whether a graft was used; if so, describe the graft source and harvest technique
Describe the degree of tendon retraction, scarring, or deficiency encountered — supports complexity and any modifier 22 claim
Record the surgical approach and closure, including any associated tenolysis or soft-tissue release
Specify laterality (left or right leg) in both the operative note and on the claim

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 24 Unrelated E/M during global 25 Significant separate E/M LT Left side RT Right side 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

27665 covers surgical repair of a leg extensor tendon when the patient has already had a prior repair attempt — making this a secondary (revision) procedure. The code applies with or without graft harvest and is reported per tendon. If two extensor tendons are addressed at the same operative session, bill 27665 twice with modifier 51 on the second line.

The leg's extensor tendons include those of the anterior compartment controlling dorsiflexion and toe extension. Secondary repairs are technically more demanding than primary repairs (27664) due to scarring, tendon retraction, and potential tissue deficiency — all of which should be documented to support the code and, where applicable, modifier 22 for unusual procedural complexity.

This code carries a 90-day global period. Routine post-op visits, dressing changes, and wound checks within that window are bundled. Separate billing for unrelated E/M services during the global requires modifier 24; a related staged procedure requires modifier 58.

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 (5.43) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (11.96) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.43
Practice expense RVU	5.66
Malpractice RVU	0.87
Total RVU	11.96
Medicare national rate	$399.47
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	$399.47
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,836.35

Common denial reasons

The recurring reasons claims for CPT 27665 get rejected.

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

Billing 27665 when there is no documented prior repair — payers may downcode to 27664 (primary repair) without clear secondary repair history
Missing laterality modifier (LT or RT), which triggers claim rejection or return for correction
Unbundling multiple tendons without modifier 51 on the second and subsequent lines, causing NCCI edit denials
Lack of graft documentation when a graft is implied — auditors flag operative notes that don't describe graft harvest or source
Post-op E/M services billed without modifier 24 during the 90-day global period, resulting in automatic bundling denial

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What makes this a secondary repair versus a primary repair (27664)?

A prior surgical repair of the same extensor tendon must have occurred. Document the original repair by date and procedure. Without that history, payers will downcode to 27664.

02If two extensor tendons are repaired in the same session, how do I bill?

Bill 27665 twice — once per tendon. Apply modifier 51 to the second (and any subsequent) line. List the highest-RVU tendon first without a modifier.

03When does modifier 22 apply here?

Modifier 22 is appropriate when operative complexity is substantially greater than typical — for example, severe adhesions, significant tendon retraction requiring extensive mobilization, or complex graft reconstruction. Document the specific findings and extra time or effort in the operative note. Without that documentation, auditors will strip the modifier and recoup the upcharge.

04Is modifier 58 or 78 correct if the patient returns to the OR within the 90-day global?

Use modifier 58 for a planned staged procedure or a procedure more extensive than originally anticipated that was anticipated at the time of the index surgery. Use modifier 78 for an unplanned return to the OR for a complication or related problem. Never invert these — a 78 error triggers global-period bundling disputes.

05Does the 90-day global cover physical therapy and post-op imaging?

No. The global bundles only physician services that are routine follow-up care. Physical therapy is billed separately by the therapist. Post-op imaging ordered by the surgeon during the global period is separately billable with the appropriate radiology code.

06Can 27665 and 27664 be billed together if both a primary and secondary extensor tendon repair are performed at the same session on the same leg?

Yes, if distinct tendons are involved — one undergoing its first repair and another undergoing a revision. Append modifier 51 to the lower-RVU code and modifier 59 or XS if needed to document the distinct tendons. The operative note must clearly identify each tendon and its repair status.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the prior repair history, the specific extensor tendon name, laterality, graft use and source, degree of scarring or retraction, and the number of tendons repaired from the surgeon's dictation. That prevents the most common audit flag for 27665: an operative note that doesn't clearly establish secondary-repair status or fails to name the tendon, leaving coders unable to distinguish this code from 27664 or justify per-tendon unbundling.

See how Mira captures CPT 27665 documentation