Surgical removal of a previously placed ankle implant, including hardware such as screws, plates, or total ankle replacement components.

Verified May 8, 2026 · 7 sources ↓

Medicare: $529.40
Work RVU: 7.61
Global, days: 90
Region: Foot & ankle

Drawn from CMSMdclarityAAPCZimmerbiometAcgme

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify implant type being removed: fixation hardware (screws, plates) vs. total ankle arthroplasty component(s)
Document the indication: pain, infection, implant failure, component loosening, allergic reaction, or staged revision protocol
Operative note must name the surgical approach and confirm open technique — not percutaneous
If modifier 22 is appended, document specific findings increasing complexity (e.g., scar tissue, broken hardware, infection, prior procedures)
For same-day 27703 + 27704, document each procedure as a distinct step with separate rationale in the operative note
Laterality must be explicit in the 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 50 Bilateral procedure 51 Multiple procedures 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

27704 covers open surgical removal of an ankle implant — whether that's fixation hardware (screws, plates) left from prior fracture repair or a failed total ankle arthroplasty (TAA) component. It sits in the repair, revision, and reconstruction section for the leg and ankle joint, not in the generic hardware removal codes (20670/20680). When the clinical scenario is specifically an ankle implant, 27704 is the correct code — not 20680, even though both involve deep hardware.

27703 (revision total ankle) and 27704 do not NCCI-bundle with each other. That's intentional: explantation of a TAA followed by revision implantation in the same session is a distinct, staged clinical scenario. If you're billing both on the same date, verify the operative note clearly documents each step as a separate distinct service and apply modifier 59 or an X-modifier if required by the payer.

The 90-day global period means all routine follow-up from the day of surgery through day 90 is bundled into the payment. An unrelated procedure in that window needs modifier 79. A complication requiring unplanned return to the OR for a related issue — such as wound dehiscence or hardware site infection — bills with modifier 78. For significantly increased intraoperative work (dense scar, retained broken hardware, prior infection), document the additional time and complexity explicitly and append modifier 22 with a cover letter; without that documentation, payers will strip the modifier.

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 (7.61) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (15.85) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.61
Practice expense RVU	6.93
Malpractice RVU	1.31
Total RVU	15.85
Medicare national rate	$529.40
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	$529.40
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 27704 get rejected.

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

Billed as 20680 (deep hardware removal) instead of 27704 — payer detects anatomical specificity mismatch
Missing laterality modifier (LT/RT) required by payer — claim returns as incomplete
Modifier 78 and 79 inverted: modifier 78 is for related unplanned return, 79 is for unrelated — swapping them triggers a denial or recoupment
Modifier 22 appended without supporting documentation of increased complexity in the operative note
Routine post-op services billed without modifier 24 during the 90-day global period

Frequently asked questions

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

01When should I use 27704 instead of 20680 for ankle hardware removal?

Use 27704 any time the hardware being removed is specifically an ankle implant — fixation hardware from prior ankle surgery or a total ankle arthroplasty component. 20680 is a general deep hardware removal code. When a more specific code like 27704 exists, use it. Payers and auditors can flag 20680 as a miscoded claim when anatomical specificity supports 27704.

02Can I bill 27703 and 27704 together on the same date?

Yes. 27703 (revision total ankle) and 27704 do not bundle per NCCI. Explantation of a failed TAA component followed by revision implantation in the same session can be billed together. Apply modifier 59 if the payer requires it, and make sure the operative note documents each step distinctly.

03What modifier applies if the patient returns to the OR for a complication related to the original ankle implant removal?

Modifier 78 — unplanned return to the operating room for a complication related to the original procedure, billed within the 90-day global. Do not use modifier 79 for this scenario; 79 is for unrelated procedures during the global period.

04Does 27704 carry a global period, and what does that mean for post-op billing?

27704 has a 90-day global period. Routine follow-up visits, dressing changes, and stitch removals through day 90 are bundled — bill them separately and you'll get denied. A visit for a problem unrelated to the ankle removal needs modifier 24 (E/M during global) or modifier 79 (unrelated procedure).

05When is modifier 22 appropriate for 27704?

Append modifier 22 when the removal required substantially more work than typical — dense pericapsular scarring, a broken or fragmented implant, prior infection with bone loss, or revision after multiple prior surgeries. Document the specific findings in the operative note. Submit a cover letter explaining the added complexity. Without that documentation, payers will deny the modifier and reduce payment to the base rate.

06Is 27704 performed in an ASC or hospital setting?

Both. CMS assigns 27704 an ASC payment indicator of A2, meaning it is covered in the ASC setting. The HOPD and ASC payment rates differ — see the Site of Service comparison table on this page. Site selection affects net reimbursement and patient cost-sharing, so verify payer contract terms for each setting.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the implant type removed (fixation hardware vs. TAA component), the surgical approach, the indication, and any complexity factors — scar tissue, broken hardware, prior infection — directly from dictation. That prevents the two most common audit flags on 27704: an operative note that doesn't justify the code over 20680, and a stripped modifier 22 because complexity wasn't explicitly documented.

See how Mira captures CPT 27704 documentation