Primary surgical repair of a single disrupted collateral ligament of the ankle, addressing acute ligamentous instability through direct tissue repair.

Verified May 8, 2026 · 6 sources ↓

Medicare: $465.61
Total RVUs: 13.94
Global, days: 90
Region: Foot & ankle

Drawn from AAPCKzanowFindacodeMdclarityAbos

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify which ligament(s) were repaired by name (e.g., ATFL, CFL, deltoid) — 'collateral ligament' alone is insufficient for audit defense.
Confirm acuity: document that the injury was acute and the ligament was directly repairable without graft or tendon transfer, distinguishing from 27698 indications.
Record the surgical approach and technique used, including any suture anchors, imbrication method, or intraoperative findings that confirm ligament disruption.
Include conservative treatment history showing failure of non-operative management prior to surgical intervention.
Document laterality (left vs. right) explicitly in both the operative note and the diagnosis codes to match claim data.
Capture anesthesia type, patient positioning, and fluoroscopy use if applicable, as these support medical necessity and facility billing.

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 25 Significant separate E/M 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

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

27695 covers primary repair of one collateral ligament of the ankle — either the lateral complex (typically the ATFL, CFL, or both as part of the lateral collateral system) or the medial deltoid ligament — following acute disruption. This is a direct repair using the patient's native tissue, distinguishing it from secondary reconstruction codes. It is the go-to code when surgery follows a discrete traumatic event and the ligament is repairable without tendon grafting or mobilization.

The code sits in a three-code family: 27695 covers one collateral ligament (primary), 27696 covers both collateral ligaments (primary), and 27698 covers secondary repair or reconstruction — used for chronic instability, failed prior repair, or when another tendon is mobilized to replace the ligament (e.g., Watson-Jones procedure). Picking the wrong code from this trio is the most common billing error on ankle ligament claims. If the operative note documents a chronic injury or graft harvest, 27695 is almost certainly wrong.

The 90-day global period means all routine post-op care through day 90 is bundled. Separate E/M visits during that window require modifier 24 for unrelated problems or modifier 25 (pre-op only). Unplanned return to the OR for a related complication uses modifier 78; a staged or planned second procedure uses modifier 58. Bilateral cases are rare but do occur — append modifier 50 and verify payer policy, as some require LT/RT instead.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.53
Practice expense RVU	6.34
Malpractice RVU	1.07
Total RVU	13.94
Medicare national rate	$465.61
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	$465.61
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,054.38

Common denial reasons

The recurring reasons claims for CPT 27695 get rejected.

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

Wrong code from the 27695/27696/27698 family — billing 27695 when the operative note describes a chronic injury or tendon graft reconstruction that maps to 27698.
Missing or vague laterality documentation causing mismatch between the operative note, ICD-10 code, and claim modifier.
Lack of documented failed conservative treatment, triggering medical necessity denial from payers requiring pre-authorization evidence.
Global period conflicts — separate E/M or procedure claims filed without appropriate modifiers (24, 78, 79) during the 90-day post-op window.
Upcoding flag when 27695 is billed but the note documents repair of both collateral ligaments, which maps to 27696.

Frequently asked questions

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

01What's the difference between 27695, 27696, and 27698?

27695 = primary repair of one collateral ligament (acute injury, direct tissue repair). 27696 = primary repair of both collateral ligaments. 27698 = secondary repair or reconstruction, used for chronic instability or when another tendon is mobilized to replace the ligament (e.g., Watson-Jones). Chronic injury or graft use pushes you to 27698 regardless of what the surgeon calls it in dictation.

02Can I bill 27695 and 27696 together if the surgeon repaired both the ATFL and CFL on the same ankle?

No. The ATFL and CFL are both part of the lateral collateral complex. Repairing both on the same ankle is captured by 27696 (both collateral ligaments), not 27695 billed twice. Billing 27695 twice for ipsilateral ligaments will trigger an NCCI bundling edit.

03What modifiers apply when 27695 is performed bilaterally?

Append modifier 50 for bilateral procedures billed on a single line, or use LT and RT on separate lines — confirm your payer's preference before submission. Medicare generally accepts modifier 50 on a single line with reimbursement at 150% of the single-procedure rate, subject to MPPR.

04How does the 90-day global period affect post-op E/M billing?

All routine follow-up through day 90 is bundled into 27695. To bill a separate E/M during the global period, use modifier 24 for an unrelated problem or modifier 25 for a significant, separately identifiable service on the day of a minor procedure. Skipping the modifier guarantees denial.

05When is modifier 78 appropriate after a 27695 repair?

Use modifier 78 if the patient has an unplanned return to the OR for a complication directly related to the original ligament repair — for example, wound dehiscence requiring irrigation and debridement. Do not use 78 for a planned staged procedure; that's modifier 58.

06Does 27695 require prior authorization, and what triggers denial without it?

Most commercial payers require prior auth for ankle ligament repair. Denials without auth are typically upheld even when medical necessity is clear. Submit auth documentation including imaging, prior conservative treatment records, and the operative plan. Medicare does not require prior auth but may audit medical necessity post-payment.

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 specific ligament repaired by name, acuity of injury, technique used, and whether any graft or tendon transfer was performed — the exact details that separate 27695 from 27696 and 27698. That prevents the most common denial on ankle ligament claims: code family misassignment caught on audit when the operative note doesn't match the billed code.

See how Mira captures CPT 27695 documentation