Surgical repair of dislocating peroneal tendons using a fibular osteotomy to create or deepen a bony groove that stabilizes the tendons in their correct anatomical position.

Verified May 8, 2026 · 7 sources ↓

Medicare: $574.16
Total RVUs: 17.19
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCAbosGenhealth

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify that peroneal tendon dislocation was confirmed clinically and/or by imaging (X-ray or MRI) prior to surgery
Describe the fibular osteotomy explicitly — technique, depth of groove created, and method of osteotomy fixation (e.g., screw or plate)
Document tendon repositioning steps and confirmation of stable seating within the deepened groove
Record anesthesia type, patient positioning, and incision location (lateral/posterolateral ankle)
Include intraoperative findings describing the degree of tendon dislocation and condition of the superior peroneal retinaculum
If superior peroneal retinaculum repair was performed, document separately to support any additional code billed

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 51 Multiple procedures 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 27676 covers open repair of chronically or acutely dislocating peroneal tendons when the procedure includes a fibular osteotomy — a deliberate cut in the fibula to deepen or reshape the peroneal groove. The osteotomy distinguishes this code from 27675, which covers the same repair without bone work. Surgeons typically fix the osteotomy site with screws or plates before closing. The code captures the full procedure: incision, tendon repositioning, bone work, internal fixation, and closure.

The 90-day global period covers all routine post-op care through day 90 — wound checks, cast or boot management, suture removal, and standard follow-up visits. Unrelated problems treated during that window require modifier 24 (E/M) or 79 (procedure). A complication requiring unplanned return to the OR for a related procedure uses modifier 78.

When peroneal tendon repair also includes a distinct primary tendon repair (e.g., peroneus brevis laceration repair billed as 27658), append modifier 51 to the secondary code. The fibular osteotomy is integral to 27676 and is not separately billable — do not stack 27707 (fibula osteotomy) alongside this code.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	8.51
Practice expense RVU	7.2
Malpractice RVU	1.48
Total RVU	17.19
Medicare national rate	$574.16
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	$574.16
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 27676 get rejected.

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

Operative note lacks explicit description of fibular osteotomy, causing payer to downcode to 27675
27707 (fibula osteotomy) billed separately when it is integral to 27676 — NCCI bundling denial
Missing laterality modifier (LT or RT) triggers claim suspension or denial by many payers
Insufficient documentation of conservative treatment failure prior to surgical intervention
Global period conflict when post-op E/M visits are billed without modifier 24 during the 90-day window

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What is the difference between 27675 and 27676?

27675 is repair of dislocating peroneal tendons without bone work. 27676 requires a fibular osteotomy — a deliberate cut to deepen the peroneal groove. If the surgeon only deepened the groove with a burr or tamp without a true osteotomy, payer auditors may challenge 27676. Document the technique precisely.

02Can 27707 (fibula osteotomy) be billed alongside 27676?

No. The fibular osteotomy is integral to 27676. Billing 27707 separately will trigger an NCCI bundling edit. The osteotomy work is captured within 27676's valuation.

03If the surgeon also repaired a peroneus brevis tendon tear during the same session, how should that be coded?

Bill 27658 (flexor tendon repair, leg, primary) or 27659 (secondary) for the tendon repair, appending modifier 51 to the lower-value code. Document both procedures distinctly in the operative note. AAPC forum consensus supports 27676 + 27658-51-LT for this scenario.

04Is modifier 50 appropriate for bilateral peroneal tendon repair?

Bilateral peroneal dislocation repairs are rare but technically billable with modifier 50 if both sides are addressed in the same session with documented bilateral pathology. Most payers require separate line items with LT and RT rather than a single line with modifier 50 — verify your payer's bilateral billing preference before submitting.

05What modifier applies if the patient returns to the OR during the 90-day global for a wound complication related to this surgery?

Use modifier 78. That signals an unplanned return to the OR for a complication related to the original procedure within the global period. Modifier 79 applies only if the return procedure is unrelated to the original surgery.

06Does the 90-day global include the patient's physical therapy referral and routine boot adjustments?

Routine post-op visits, dressing changes, and cast or boot management by the operating surgeon are included in the global and not separately billable. PT services rendered by a separate provider are not subject to the global and bill independently.

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 fibular osteotomy technique from dictation — groove depth, fixation hardware used, and the step-by-step tendon repositioning sequence. It also flags whether the superior peroneal retinaculum was repaired, prompting the coder to evaluate an additional code. This prevents the most common audit failure for 27676: an operative note that describes bone work but doesn't use the word 'osteotomy,' triggering a downcode to 27675.

See how Mira captures CPT 27676 documentation