Soft tissue repair · Foot & ankle
Below-knee amputation performed through both the tibia and fibula, with skin flap closure of the residual limb.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $822.66
- Total RVUs
- 24.63
- Global, days
- 90
- Region
- Foot & ankle
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 6 cited references ↓
- Level of amputation documented in centimeters below the tibial plateau or by anatomical landmark (proximal, mid, distal shaft)
- Indication for amputation explicitly stated: peripheral artery disease, diabetic gangrene, traumatic injury, malignancy, or refractory infection
- Description of skin flap technique used and confirmation that flaps were closed (distinguishes 27880 from 27882 guillotine)
- Vascular and nerve management described: vessels ligated, nerves transected and managed to reduce neuroma risk
- Whether immediate cast or prosthetic fitting was applied at time of surgery (if yes, 27881 applies instead of 27880)
- Laterality documented: left or right lower extremity
- Anesthesia type and any co-surgeon or assistant involvement noted in the operative report
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 6 cited references ↓
27880 covers a standard below-knee amputation (BKA) in which the surgeon transects both the tibia and fibula, manages the associated vasculature and nerves, shapes the residual soft tissue for eventual prosthetic fitting, and closes the skin flaps over the stump. This is the go-to code for the most commonly performed below-knee amputation technique. It is distinct from 27881 (same procedure plus immediate cast application for prosthetic preparation) and 27882 (open guillotine amputation, no flap closure).
The 90-day global period is significant here. All routine wound checks, dressing changes, and stump-shaping visits through day 90 are bundled. Unrelated E/M visits in that window require modifier 24. If a complication drives a return to the OR for a related procedure — stump revision, wound dehiscence repair — use modifier 78. An unrelated surgical procedure in the global window gets modifier 79.
CMS assigns 27880 status indicator C for hospital outpatient (HOPD) settings, meaning it is designated as an inpatient-only procedure under Medicare. Do not bill 27880 under the HOPD PPS — it will deny. The procedure is performed in an inpatient hospital setting for Medicare patients. Vascular surgery and general surgery bill this code alongside orthopedics, so multi-specialty teams should confirm which surgeon is the primary billing provider.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 14.99 |
| Practice expense RVU | 5.97 |
| Malpractice RVU | 3.67 |
| Total RVU | 24.63 |
| Medicare national rate | $822.66 |
| 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 | $822.66 |
HOPD (APC 5114) Hospital outpatient department | $7,413.38 |
ASC (PI G2) Ambulatory surgical center (freestanding) | $3,695.53 |
Common denial reasons
The recurring reasons claims for CPT 27880 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Billed to HOPD/ASC under Medicare — 27880 is inpatient-only (status indicator C); outpatient facility claims deny on site-of-service grounds
- Missing or ambiguous laterality — payer unable to adjudicate without LT or RT modifier
- Incorrect code selection: guillotine technique documented in the operative note but 27880 billed instead of 27882
- Global period conflict — post-op E/M visits billed without modifier 24, triggering bundling denial
- Diagnosis code mismatch — ICD-10 does not support medical necessity for the level of amputation performed
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What is the difference between 27880, 27881, and 27882?
02Can 27880 be billed in a hospital outpatient or ASC setting under Medicare?
03Which modifiers are required for laterality?
04How does the 90-day global period affect post-op billing?
05What ICD-10 diagnosis codes are commonly paired with 27880?
06If a vascular surgeon and an orthopedic surgeon both operate, how is billing handled?
07When would modifier 58 apply to 27880?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02aapc.comhttps://www.aapc.com/codes/cpt-codes/27880
- 03aapc.comhttps://www.aapc.com/codes/coding-newsletters/my-orthopedic-coding-alert/reader-question-most-leg-amputations-warrant-27880-article
- 04cms.govhttps://www.cms.gov/medicare/medicare-fee-for-service-payment/hospitaloutpatientpps/downloads/cms-1427-p_adde.pdf
- 05axogeninc.comhttps://www.axogeninc.com/wp-content/uploads/2024/05/2024-Neurectomy-Post-Amputation-Coding-and-Billing-Guide-MKTG-0082.pdf
- 06cms.govhttps://www.cms.gov/files/document/2024-official-icd-10-pcs-coding-guidelines-updated-12/19/2023.pdf
Mira AI Scribe
Mira's AI scribe captures the amputation level relative to the tibial plateau, the technique used (flap closure vs. open guillotine), laterality, vascular and nerve management details, and the indication driving the procedure. That documentation set locks in 27880 vs. 27881 vs. 27882 code selection and prevents downcoding or denial from an operative note that omits flap closure confirmation or leaves laterality ambiguous.
See how Mira captures CPT 27880 documentation