Joint replacement · Foot & ankle

27702

Total ankle arthroplasty with implant — surgical replacement of the tibiotalar joint using a prosthetic device to eliminate pain and restore motion.

Verified May 8, 2026 · 7 sources ↓

Medicare
$885.12
Total RVUs
26.5
Global, days
90
Region
Foot & ankle
Drawn from CMSNIHZimmerbiometCgsmedicareAAOS

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

  • Laterality (left or right ankle) documented in the operative note and on the claim
  • Implant manufacturer, model, and component sizes recorded in the operative report
  • Approach named explicitly — anterior or lateral; 'standard approach' flags audits
  • Duration and nature of conservative treatment failure before surgical intervention
  • Pre-operative imaging (weight-bearing X-rays, CT if applicable) confirming joint destruction
  • Intraoperative fluoroscopy use noted; do not bill fluoroscopy separately — it is integral to the procedure
  • Diagnosis-procedure alignment: ICD-10 code must reflect ankle-specific pathology, not generic joint disease

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 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 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 7 cited references ↓

CPT 27702 describes total ankle replacement: the surgeon resects the distal tibia and talar dome, then implants a multi-component prosthetic system (tibial, talar, and typically a polyethylene bearing) to reconstruct the joint. The procedure targets end-stage ankle arthritis, post-traumatic deformity, or severe osteonecrosis where joint-preserving options have failed. It is performed under general or regional anesthesia via an anterior or lateral approach.

27702 carries a 90-day global period. That covers the day-before visit, the operative day, and all routine postoperative management through day 90 — wound checks, cast changes, and standard follow-up visits are all bundled. Bill modifier 24 for unrelated E/M visits and modifier 79 for unrelated procedures within that window. A staged revision billed by the same surgeon uses modifier 58. Laterality modifiers LT and RT are required; payers routinely reject claims without them.

ICD-10 diagnosis must support medical necessity — primary osteoarthritis (M19.071/M19.072), post-traumatic osteoarthritis (M19.171/M19.172), or rheumatoid arthritis with foot involvement are the most-accepted primary diagnoses. Document failed conservative treatment and functional limitation explicitly. Inpatient hospital cases map to MS-DRG 469 (with MCC) or 470 (without MCC), though total ankle may also land in DRG 515–517 depending on complication coding.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU14.06
Practice expense RVU9.8
Malpractice RVU2.64
Total RVU26.5
Medicare national rate$885.12
Global period90 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

SettingMedicare rate (national)
Office (PFS non-facility)
Procedure performed in physician's office
$885.12
HOPD (APC 5117)
Hospital outpatient department
$27,721.73
ASC (PI J8)
Ambulatory surgical center (freestanding)
$21,837.31

Common denial reasons

The recurring reasons claims for CPT 27702 get rejected.

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

  • Missing laterality modifier (LT or RT) — most payers auto-deny without it
  • ICD-10 diagnosis code maps to a different joint or lacks specificity for ankle
  • Conservative treatment not documented prior to authorization, triggering medical necessity denial
  • Separately billed fluoroscopy or intraoperative imaging bundled into 27702 by NCCI edit
  • Global period violation — routine post-op visit billed without modifier 24 within 90-day window
  • Implant charges billed without corresponding operative note detailing the prosthetic system used

Frequently asked questions

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

01Is a laterality modifier required for 27702?
Yes. Append LT or RT on every claim. Most Medicare contractors and commercial payers will auto-deny 27702 without a laterality modifier. Modifier 50 applies only if both ankles are replaced in the same operative session, which is rare.
02What is the global period for 27702?
90 days. The global includes the day-before preoperative visit, the operative day, and all routine post-op care through day 90. Unrelated E/M visits need modifier 24. An unrelated surgical procedure in that window needs modifier 79. A planned staged procedure by the same surgeon uses modifier 58.
03Can I bill fluoroscopy separately when performed during total ankle replacement?
No. Per CMS NCCI policy, fluoroscopy performed during an orthopedic reconstruction procedure is integral to the procedure. Billing a separate fluoroscopy code will trigger a bundling denial.
04How does 27702 differ from 27703?
27702 is the primary total ankle arthroplasty with implant. 27703 is the revision — used when one or more components of a prior total ankle replacement require removal and reimplantation. If the implant is only being removed without replacement, use 27704.
05What ICD-10 codes best support medical necessity for 27702?
Primary osteoarthritis of the ankle (M19.071 right, M19.072 left) and post-traumatic osteoarthritis (M19.171 right, M19.172 left) are most consistently accepted. Rheumatoid arthritis with ankle involvement also supports the claim. Document failed conservative management — the absence of that history is a leading authorization denial trigger.
06Can 27702 be performed in an ASC setting under Medicare?
As of the Zimmer Biomet coding reference and current CMS OPPS indicators, 27702 carries an OPPS status indicator of C for hospital outpatient, meaning Medicare does not separately reimburse it under OPPS — it is typically covered under inpatient-only or facility-specific rules. Verify current CMS OPPS addenda before scheduling as outpatient under Medicare; ASC payment indicators also apply only to eligible facility settings.
07When is modifier 22 appropriate for 27702?
Modifier 22 applies when operative complexity substantially exceeds typical — severe deformity requiring custom cuts, significant scar tissue from prior surgery, or prolonged operative time well above the norm. Attach a cover letter quantifying the additional work. Payers require documentation; modifier 22 without supporting notes is routinely disallowed.

Sources & references

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

  1. 01CMS Physician Fee Schedule 2026
  2. 02
    vsac.nlm.nih.gov
    https://vsac.nlm.nih.gov/context/cs/codesystem/CPT/version/2019/code/27702/info
  3. 03
    cms.gov
    https://www.cms.gov/files/document/04-chapter4-ncci-medicare-policy-manual-2025finalcleanpdf.pdf
  4. 04
    zimmerbiomet.com
    https://www.zimmerbiomet.com/content/dam/zb-corporate/en/products/specialties/foot-&-ankle/trabecular-metal-total-ankle-system/anklecodingreferenceguide.pdf
  5. 05
    cgsmedicare.com
    https://www.cgsmedicare.com/medicare_dynamic/j15/partb/ptpb/ptp.aspx
  6. 06
    aaos.org
    https://www.aaos.org/quality/coding-and-reimbursement/
  7. 07
    aahks.org
    https://www.aahks.org/practice-resources/coding-resource-center/

Mira AI Scribe

Mira's AI scribe captures the implant system by name, component sizes, surgical approach, intraoperative fluoroscopy use, and laterality directly from dictation — then flags if the operative note omits the approach name or implant details. That prevents the two most common TAR audit findings: vague approach documentation and missing implant records that trigger post-payment review.

See how Mira captures CPT 27702 documentation

Related CPT codes

28575 $422.52
Closed treatment of a talotarsal joint dislocation performed under anesthesia — meaning the dislocated joint between the talus and an adjacent tarsal bone is manually reduced without surgical opening, but anesthesia is required to achieve it.
27646 $1,389.81
Radical resection of a tumor from the fibula, including removal of wide margins of surrounding normal bone and soft tissue.
27827 $1,053.13
Open surgical fixation of a pilon or tibial plafond fracture involving the weight-bearing articular surface of the distal tibia, with internal fixation of the tibia only.
27659 $446.57
Secondary repair of one or more flexor tendons of the leg, performed after a prior repair attempt, with or without tendon graft placement.
Ready?

Ready to transform your orthopedic practice?

See how orthopedic practices are running documentation, billing, and operations on a single voice-first platform.

Get started for free