Revision of a previously placed total ankle replacement — removal and reimplantation of prosthetic components to address loosening, wear, malalignment, or failure of the primary implant.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,017.73
Total RVUs: 30.47
Global, days: 90
Region: Foot & ankle

Drawn from CMSAetnaAAPCFindacodeFastrvu

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative note identifying the failed components removed and new components implanted by name and size
Pre-operative imaging (weight-bearing radiographs, CT if applicable) documenting the failure mode — loosening, subsidence, malalignment, or fracture
Documented failure of the primary total ankle replacement with clinical rationale for revision rather than conversion to arthrodesis
Bone stock assessment and any grafting performed, including graft type and source
Prior authorization documentation if required by the payer, including clinical criteria met
Laterality clearly stated in the operative note and on the claim (LT or RT modifier)

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 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27703 covers surgical revision of a total ankle arthroplasty. The surgeon reopens the original operative site, removes failed or compromised prosthetic components, prepares the underlying bone surfaces, and implants new tibial and talar components. Indications include aseptic loosening, polyethylene insert wear, component subsidence, periprosthetic fracture, or progressive malalignment following the primary total ankle replacement (27702). This is a substantially more complex undertaking than the index procedure — bone loss management, ligament balancing, and the need for augmented implants or bone graft are common.

The 90-day global period means all routine post-op care through day 90 is bundled. Any visit or service unrelated to the revision — including management of a new problem — requires modifier 24 on E/M codes within that window. If you're billing 27703 and 27704 (implant removal) together, NCCI does not bundle them, but document the distinct work for each service clearly in the operative note.

Major payers including Aetna cover 27703 when specific clinical criteria are met — typically documented implant failure with radiographic correlation, failure of conservative measures, and adequate bone stock to support revision components. Osteoporosis, osteonecrosis, and active infection at the ankle site are common coverage exclusions. Pre-authorization is standard for this code across commercial payers.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	16.52
Practice expense RVU	10.82
Malpractice RVU	3.13
Total RVU	30.47
Medicare national rate	$1,017.73
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	$1,017.73
HOPD (APC 5116) Hospital outpatient department	$17,913.59
ASC (PI J8) Ambulatory surgical center (freestanding)	$14,025.67

Common denial reasons

The recurring reasons claims for CPT 27703 get rejected.

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

Missing or insufficient prior authorization — most commercial payers require pre-auth for revision total ankle arthroplasty
ICD-10 diagnosis code does not match payer-accepted indications — osteoporosis and osteonecrosis are excluded by multiple payers including Aetna
Operative note lacks documentation of implant failure mode, making medical necessity determination impossible
Unbundling dispute when 27703 and 27704 are billed together without distinct documentation of separate work for each service
Global period conflict — post-op E/M visits billed without modifier 24 when unrelated to the revision

Frequently asked questions

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

01Can 27703 and 27704 be billed together on the same date?

Yes. NCCI does not bundle 27703 and 27704, so both can appear on the same claim. Document the distinct work for each in the operative note — implant removal and the reconstruction are separate billable services.

02What modifier is required when 27703 is performed on a clearly identified side?

Use LT for left or RT for right. Laterality is required on the claim and must match the operative note. Omitting it is a common clean-claim failure point.

03Does the 90-day global period from the primary total ankle (27702) affect billing of 27703?

If 27703 is a planned staged revision, bill with modifier 58. If it's an unplanned return to the OR for a complication related to the primary procedure, use modifier 78. Modifier 79 applies only if the revision is for a completely unrelated condition — which is rarely the case here.

04What ICD-10 codes support medical necessity for 27703?

Aseptic loosening of a joint prosthesis (T84.03xA/D/S), mechanical loosening of a prosthetic joint, periprosthetic fracture, and implant wear are the typical supporting diagnoses. Active infection and osteoporosis-only presentations are excluded by major payers including Aetna.

05Is modifier 22 ever appropriate for 27703?

Yes, when the revision involves substantially greater work than typical — significant bone loss requiring structural allograft, complex ligament reconstruction, or management of a periprosthetic fracture. The operative note must quantify the added complexity and time. Attach a cover letter to the claim explaining the increased work.

06How does site of service affect reimbursement for 27703?

HOPD and ASC payments differ materially — see the Site of Service comparison table on this page. The physician's professional fee is the same regardless of setting, but facility fees vary significantly between hospital outpatient and ASC. Most revision total ankle cases require a hospital setting given complexity.

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 failure mode of the primary implant, component names and sizes removed and reimplanted, bone preparation technique, any grafting performed, and final alignment confirmation from the operative dictation. That detail directly supports medical necessity review and prevents the most common denial path for 27703 — an operative note that describes the revision without establishing why the primary implant failed.

See how Mira captures CPT 27703 documentation