Tenolysis of multiple flexor or extensor tendons in the leg and/or ankle, performed through separate incisions to free adhesions and restore function.

Verified May 8, 2026 · 6 sources ↓

Medicare: $489.66
Total RVUs: 14.66
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCAbosFacsMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify each tendon released by name (e.g., flexor hallucis longus, peroneus brevis, tibialis anterior)
Confirm that each tendon was accessed through a separate, distinct incision — not a shared incision
Document the pathology justifying tenolysis: adhesions, scar tissue, prior surgical or traumatic history
Record pre-op functional deficits and intraoperative findings demonstrating tendon tethering
Note any concurrent procedures performed and the anatomic sites to support separate billing if applicable
Include post-op plan and anticipated recovery to substantiate medical necessity under a 90-day global

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 58 Staged or related 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 6 cited references ↓

CPT 27681 covers tenolysis of multiple flexor or extensor tendons in the leg and/or ankle when each tendon is released through its own separate incision. This distinguishes it from 27680, which covers a single tendon. The procedure frees tendons bound by adhesions — commonly following trauma, prior surgery, or inflammatory conditions — to restore gliding mechanics, reduce pain, and improve ankle and foot function.

The 90-day global period means all routine post-op visits, wound checks, and dressing changes through day 90 are bundled. Any E/M service for an unrelated problem during that window requires modifier 24. A new procedure for a related indication during the global requires modifier 78; an unrelated procedure requires modifier 79.

Don't confuse 27681 with 27680 (single tendon) or 27685/27686 (tendon lengthening or shortening). The operative note must name each tendon released and confirm a distinct incision for each — otherwise reviewers will downcode to 27680 or deny multiple-tendon billing outright.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.87
Practice expense RVU	6.55
Malpractice RVU	1.24
Total RVU	14.66
Medicare national rate	$489.66
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	$489.66
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 27681 get rejected.

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

Downcode to 27680 when the operative note fails to confirm separate incisions for each tendon
Bundling denial when 27681 is billed same-day with overlapping soft-tissue codes without modifier 59 or XS
Medical necessity denial when documentation lacks objective findings of adhesions or functional deficit
Global period violation when post-op E/M visits are billed without modifier 24 for unrelated conditions
Missing laterality modifier (LT or RT) causing claim rejection or processing delay

Frequently asked questions

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

01What separates 27681 from 27680?

27680 is for a single tendon; 27681 requires multiple tendons released through separate incisions. If you use one incision to access two tendons, 27681 does not apply — the operative note must document a distinct incision per tendon.

02Can 27681 and 27680 be billed together on the same date?

Generally no — 27681 already covers the multiple-tendon scenario. Billing both on the same date for the same leg invites a bundling denial. If tendons on opposite legs are released, use laterality modifiers LT and RT and confirm bilateral billing rules with the payer.

03Is modifier 50 appropriate if both legs are operated on in the same session?

It can be, but payer rules vary. Some require modifier 50 appended to a single line; others want two separate line items with LT and RT. Verify with each payer before submitting — Medicare and commercial carriers handle this differently.

04What ICD-10 diagnoses support medical necessity for 27681?

Commonly paired diagnoses include tendon adhesions (M67.8x), tenosynovitis (M65.xx), acquired tendon contracture (M67.xx), and post-traumatic or post-surgical stiffness. The diagnosis must align with the specific tendons and anatomic region documented in the operative note.

05Does the 90-day global affect billing for physical therapy or cast changes?

The global covers the surgeon's post-op services, not independently billing physical therapists. PT codes billed by a separate PT provider are not affected. However, if the surgeon's own staff performs routine dressing changes or cast checks, those are bundled and cannot be billed separately during the 90-day window.

06When is modifier 22 appropriate for 27681?

Use modifier 22 when the procedure required substantially more work than typical — for example, severe scarring from multiple prior surgeries, extensive adhesion involvement, or unusual anatomic complexity. Attach a cover letter quantifying the additional time and effort; without supporting documentation, payers routinely ignore modifier 22 and pay the base rate.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures each tendon released by anatomical name, the approach used for each, and the surgeon's intraoperative description of adhesion extent and tendon excursion before and after release. It flags operative notes that reference only a generic 'tendon release' without naming individual tendons or confirming separate incisions — the two documentation gaps most likely to trigger a downcode from 27681 to 27680.

See how Mira captures CPT 27681 documentation