Transfer or transplant of a single superficial tendon in the lower leg, including any muscle redirection or rerouting performed as part of the same procedure.

Verified May 8, 2026 · 6 sources ↓

Medicare: $608.23
Work RVU: 8.94
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCAAOSEmednyAacpm

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify the specific tendon(s) transferred by name (e.g., anterior tibial tendon, peroneus longus) — not just 'single tendon transfer'.
Document the underlying indication: paralysis, irreparable injury, spastic deformity, or other neuromuscular pathology.
Specify that the tendon transferred is superficial, not deep — this distinguishes 27690 from 27691 and prevents downcoding audits.
Record the donor site, recipient attachment point, and fixation method used (bone tunnel, interference screw, suture anchor, etc.).
Document any muscle redirection or rerouting performed, as these are explicitly included in the procedure and must be noted to justify the code.
Capture preoperative functional deficit and intraoperative findings confirming the need for transfer rather than primary repair.

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 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27690 covers the surgical transfer or transplant of a single superficial tendon in the lower leg, typically performed to restore function lost to injury, paralysis, or disease. A classic example is transfer of the anterior tibial tendon extensor into the midfoot. The tendon is detached from its origin or insertion and rerouted to a new attachment point, redistributing the motor force to compensate for a dysfunctional muscle-tendon unit.

This code applies only to superficial tendon transfers. Deep tendon transfers in the same region bill under 27691. Each additional tendon transferred through a separate incision is reported with an additional unit of the appropriate code; multiple tendons through the same incision have their own descriptor. The 90-day global period means all routine post-op care is bundled — use modifier 58 for planned staged procedures in that window, modifier 78 for unplanned returns related to the index procedure, and modifier 79 for unrelated procedures.

The code falls under the Repair, Revision, and/or Reconstruction section for the leg (tibia and fibula) and ankle joint. Orthopedic surgery, podiatry, and plastic/reconstructive surgery are the top billing specialties. Site of service matters: HOPD and ASC payments differ substantially, so confirm your facility contract before setting patient estimates.

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 (8.94) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (18.21) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	8.94
Practice expense RVU	7.91
Malpractice RVU	1.36
Total RVU	18.21
Medicare national rate	$608.23
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	$608.23
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 27690 get rejected.

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

Operative note lacks explicit confirmation that the transferred tendon is superficial — payers downcode to a lower-value repair code when depth is unspecified.
27690 billed for a deep tendon transfer that should be coded as 27691, triggering a clinical mismatch denial on audit.
E&M visit on the same day as surgery submitted without modifier 25 (if a significant separately identifiable evaluation occurred) — denied as bundled into the global package.
Multiple tendon transfers incorrectly billed as multiple units of 27690 when a different descriptor applies for deep or multiple-tendon procedures.
Missing medical necessity documentation — payers require evidence of functional deficit (e.g., drop foot, spastic equinus) that justifies transfer rather than less invasive management.

Frequently asked questions

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

01What separates 27690 from 27691?

Depth of the transferred tendon. 27690 is for superficial tendon transfers; 27691 covers deep tendon transfers in the same region. The operative note must explicitly identify the tendon and its depth — auditors flag notes that don't specify superficial or deep.

02Can I bill 27690 more than once if I transfer two tendons in the same session?

Only if the transfers are performed through separate incisions and the tendons are both superficial. Multiple tendons through the same incision have a separate descriptor. Review the applicable code set and your payer's MUE for 27690 before billing a second unit.

03Is modifier 51 appropriate when 27690 is billed alongside another procedure on the same day?

Yes, when 27690 is the secondary procedure in a same-session multi-procedure claim, modifier 51 signals that the standard multiple-procedure reduction applies. Some payers auto-apply the reduction — confirm your payer's policy to avoid over- or under-reduction.

04What modifier applies if the patient returns to the OR during the 90-day global for a complication related to the tendon transfer?

Modifier 78 — unplanned return to the OR for a related procedure during the postoperative period. Do not use modifier 79, which is reserved for procedures unrelated to the index surgery. Confusing these two is a common audit finding.

05Can an E&M be billed the day of a 27690 procedure if I conducted a significant separate evaluation?

Yes, but only with modifier 25 appended to the E&M code, and documentation must show a significant, separately identifiable service beyond the pre-procedure assessment. The decision for a major surgery (90-day global) made the day before or day of surgery uses modifier 57 on the E&M instead.

06Does the 90-day global include the surgical day itself?

Yes. The global period for 27690 starts the day of surgery and runs 90 days forward. The day before surgery is also in the preoperative package. Any related care in that window is bundled unless a applicable modifier justifies separate billing.

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, depth (superficial vs. deep), donor and recipient attachment sites, fixation technique, and any muscle rerouting from dictation — the exact details that distinguish 27690 from 27691 and prevent depth-based downcoding on audit. It also flags when the operative note omits confirmation of superficial transfer, so coders aren't selecting a code on incomplete documentation.

See how Mira captures CPT 27690 documentation