Primary end-to-end repair of both the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) of the ankle in a single operative session.

Verified May 8, 2026 · 5 sources ↓

Medicare: $510.37
Total RVUs: 15.28
Global, days: 90
Region: Foot & ankle

Drawn from BeckersascAAPCCMS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify both ligaments repaired by name: ATFL and CFL — do not just document 'lateral ankle ligament repair'.
Document the repair technique explicitly as end-to-end (direct) suture approximation to support primary repair code selection over 27698.
If Gould modification is performed, note that retinaculum advancement was used to reinforce the primary repair — do not bill it separately.
Record pre-op diagnosis of lateral ankle instability with mechanism of injury (e.g., recurrent inversion sprains, acute ligamentous disruption).
Document intraoperative findings for both the ATFL and CFL, including ligament quality, degree of disruption, and tissue used for repair.
Note laterality (left vs. right) to support modifier LT or RT on the claim.

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 51 Multiple procedures 57 Decision for surgery 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 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 5 cited references ↓

27696 covers a primary repair of both ankle collateral ligaments — the ATFL and CFL — where each ligament is sutured end-to-end. The classic Brostrom procedure is the prototype: disrupted ligament ends are directly approximated and sutured, restoring the lateral stabilizers of the ankle. If the surgeon reinforces the repair by advancing the extensor retinaculum over it (the Gould modification), that work is bundled into 27696 and not separately reportable. Per AAOS, retinaculum transfer or mobilization is included in the global service.

Code selection turns on technique, not timing. The distinction between primary (27695/27696) and secondary (27698) repair is not about whether the injury is acute or chronic — it is about whether the native ligament ends are sutured directly together. A reconstruction that reroutes the peroneus brevis tendon (Evans, Chrisman-Snook, Watson-Jones) is a secondary repair reported with 27698. If only one collateral ligament is repaired end-to-end, use 27695 instead. Both ligaments must be repaired for 27696 to apply.

27696 carries a 90-day global period. All routine post-op office visits, dressing changes, and suture removals through day 90 are included. Unrelated E/M services during the global require modifier 24; a significant separately identifiable E/M on the day of surgery requires modifier 25. Casting and splinting applied at the time of surgery are bundled under NCCI rules and are not separately billable for the same anatomic area.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	8.37
Practice expense RVU	5.79
Malpractice RVU	1.12
Total RVU	15.28
Medicare national rate	$510.37
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	$510.37
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,352.64

Common denial reasons

The recurring reasons claims for CPT 27696 get rejected.

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

Code selected as 27696 when operative note describes only one ligament repaired — 27695 is the correct code in that scenario.
Downcoded to 27695 or denied when documentation says 'standard lateral ankle repair' without naming both the ATFL and CFL as individually repaired.
Claim denied or bundled when Gould modification is billed separately instead of being treated as integral to the primary repair.
Payer reclassifies to 27698 (secondary repair) when the surgeon's note mentions chronic instability — primary vs. secondary is technique-based, not timing-based; lack of explicit end-to-end suture language invites this error.
Casting or strapping billed same-day for the operative ankle triggers NCCI edit denial — post-op immobilization is bundled under the musculoskeletal global service rules.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What is the difference between 27695, 27696, and 27698?

27695 = primary repair of one collateral ligament (end-to-end suture). 27696 = primary repair of both collateral ligaments (ATFL and CFL, end-to-end). 27698 = secondary repair/reconstruction, such as Evans, Chrisman-Snook, or Watson-Jones, where tendon tissue is rerouted to reconstruct ligament function rather than reapproximating native ends.

02Can I bill 27696 when the injury is chronic, not acute?

Yes. Per guidance from the AMA, primary vs. secondary classification is based on technique — direct end-to-end suture of the ligament ends — not on how long ago the injury occurred. A Brostrom repair for chronic instability is still a primary repair and reported with 27695 or 27696.

03Is the Gould modification separately billable on top of 27696?

No. AAOS includes retinaculum transfer or mobilization as part of the primary repair global service. Billing a separate code for the Gould modification is incorrect and will be denied or recouped on audit.

04Should I use modifier 59 if I repair the ankle ligaments at the same session as another foot-ankle procedure?

Only if NCCI bundles the codes and the work is genuinely distinct. Check the NCCI edits for the specific code pair. If the second procedure is at a separate anatomic site and separately documented, modifier 59 or XS may apply — but do not append reflexively.

05What happens if post-op casting is billed on the same date as 27696?

NCCI bundles casting and splinting codes into musculoskeletal surgical procedures performed on the same anatomic area. Strapping or casting the operative ankle on the day of surgery is not separately payable.

06What modifier is required for an E/M visit during the 90-day global period for an unrelated problem?

Modifier 24. Use it on the E/M to indicate the visit is unrelated to the ankle ligament repair. Without it, the claim will deny as included in the global period.

07Does 27696 require both the ATFL and CFL to be repaired to use the code?

Yes. Both collateral ligaments must be repaired end-to-end. If only one is repaired, report 27695 instead. Billing 27696 when only one ligament is documented is an upcoding risk.

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 ligaments operated on (ATFL, CFL, or both), the repair technique (end-to-end suture vs. tendon transfer), and any retinaculum augmentation from the surgeon's dictation. That distinction between 27695, 27696, and 27698 lives entirely in operative language — vague documentation is the single most common reason these claims are downcoded or reclassified on audit.

See how Mira captures CPT 27696 documentation