Below-knee amputation performed using an open, circular (guillotine) technique through the tibia and fibula, without creation of a skin flap.

Verified May 8, 2026 · 5 sources ↓

Medicare: $552.45
Work RVU: 9.55
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCEmednyAxogeninc

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Explicit statement of the open, circular (guillotine) technique — not just 'below-knee amputation'
Clinical justification for emergent approach: document ascending infection/necrosis trajectory or hemodynamic instability that precluded flap closure
Anatomic level of transection through tibia and fibula with laterality (right vs. left)
Intraoperative findings including extent of tissue necrosis, vascular compromise, or contamination driving technique selection
Post-operative wound status and plan for subsequent closure or revision, including anticipated follow-up procedure

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure LT Left side RT Right side 59 Distinct service 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 27882 describes a guillotine-style transtibial amputation — an open, circular transection through both the tibia and fibula with no skin flap closure. This technique is chosen specifically for emergent situations: rapidly ascending infection or necrosis, or hemodynamic instability where a definitive flap closure would be unsafe. The open wound is managed post-operatively and typically requires a subsequent closure or revision procedure (see 27884 for secondary closure/scar revision).

Because 27882 is a distinctly different technique from the standard transtibial amputation (27880) or the immediate-fit cast variant (27881), the operative note must make the emergent rationale and open circular technique explicit. Auditors and payers will scrutinize whether the guillotine approach was clinically justified versus simply underdocumented flap closure. The 90-day global period applies, covering all routine post-op care through day 90.

Side-specific modifiers (LT/RT) are required for correct laterality reporting. Modifier 50 applies only if bilateral guillotine amputations are performed at the same session — a rare clinical scenario. Any return to the OR within the global for wound revision or definitive closure related to this amputation uses modifier 78; unrelated procedures in the same window use modifier 79.

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 (9.55) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (16.54) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	9.55
Practice expense RVU	4.61
Malpractice RVU	2.38
Total RVU	16.54
Medicare national rate	$552.45
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	$552.45
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI G2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 27882 get rejected.

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

Operative note documents 'amputation below knee' without specifying open circular/guillotine technique, triggering down-code to 27880
Missing or insufficient clinical justification for emergent guillotine approach — payer treats as incomplete documentation
Laterality modifier (LT or RT) absent, causing claim rejection or pend for bilateral clarification
Subsequent closure or revision billed without modifier 78 during the 90-day global period, denied as included service
ICD-10 diagnosis code does not support emergent vascular or infectious indication, creating medical necessity mismatch

Frequently asked questions

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

01What makes 27882 different from 27880?

27880 is a standard transtibial amputation with skin flap creation. 27882 is an open, circular (guillotine) transection with no flap — wound is left open intentionally. The technique difference must be documented explicitly or the claim will be down-coded to 27880.

02When is the guillotine technique clinically appropriate to bill?

27882 is appropriate when emergent limb removal is required to halt ascending infection, necrotizing fasciitis, or gas gangrene, or when hemodynamic instability makes a longer flap closure unsafe. Document the specific emergent indication in the operative note.

03Do I need a separate code for the subsequent wound closure?

Yes. Guillotine amputation leaves the wound open by design. Definitive closure or revision is coded separately — 27884 covers secondary closure or scar revision at the same transtibial level. Bill 27884 with modifier 78 if it occurs within the 90-day global period of 27882.

04Is modifier 50 appropriate for 27882?

Only if bilateral guillotine amputations are performed at the same operative session, which is a rare clinical event. More commonly, apply LT or RT to the single affected limb. Do not use 50 reflexively for amputation procedures.

05What global period applies to 27882, and what does it include?

27882 carries a 90-day global period. That covers the day-before pre-op visit, the surgery date, and all routine post-op management through day 90. Wound checks, dressing changes, and stitch/staple removal are bundled. Unrelated services in that window require modifier 79; related unplanned return-to-OR procedures require modifier 78.

06Which ICD-10 diagnosis codes support 27882?

Common supporting diagnoses include peripheral artery disease with critical limb ischemia, necrotizing fasciitis, gas gangrene, diabetic foot infection with osteomyelitis, and severe crush injury with vascular compromise. The diagnosis code must reflect the emergent nature of the case to support the guillotine technique medically.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the operative technique by name (open circular/guillotine), the emergent clinical indication (ascending necrosis, sepsis, hemodynamic instability), transection level, and laterality directly from dictation. That prevents the most common audit flag — an operative note that documents a below-knee amputation without distinguishing the guillotine approach from a standard flap closure, which drives down-coding to 27880 and triggers medical necessity denials.

See how Mira captures CPT 27882 documentation