Re-amputation through the tibia and fibula, performed when a prior below-knee amputation stump requires revision at a more proximal level due to ischemia, infection, or wound breakdown.

Verified May 8, 2026 · 6 sources ↓

Medicare: $601.88
Work RVU: 9.77
Global, days: 90
Region: Foot & ankle

Drawn from JvascsurgGenhealthZhealthpublishingAAPCCMS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify the prior amputation level and date to establish this is a re-amputation, not an initial procedure.
Document the indication for revision: ischemia, infection, wound breakdown, or necrosis — with supporting clinical findings.
Operative note must confirm resection through both tibia and fibula; note if only one bone was cut and why.
Describe flap creation, bone contouring, and stump closure technique in detail.
Include preoperative imaging (X-ray, MRI, or vascular study) that supports the medical necessity of a higher amputation level.
If modifier 52 is appended for partial procedure, document exactly what was and was not performed and the clinical rationale.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 58 Staged or related 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27886 describes a re-amputation through the tibia and fibula — specifically, a situation where an existing below-knee amputation (BKA) stump is revised to a higher level on the same bones. The classic scenario: a low BKA fails due to ischemia, non-healing ulceration, or stump infection, and the surgeon converts it to a high BKA. That is 27886. It is not the code for the initial BKA (27880/27881/27882), and it is not the code for a BKA converted to an above-knee amputation — that revision uses 27590/27591.

Distinguishing 27886 from adjacent codes is the dominant coding challenge here. CPT 27884 covers closure of a guillotine-type open amputation wound, while 27886 applies when a patient with a closed prior amputation requires re-amputation at a higher tibial/fibular level. If only one bone is cut — for example, tibia only with no fibula involvement — 27886 with modifier 52 has been discussed in the coding community as a potential approach, though documentation must clearly support the deviation from the standard bilateral bone resection described by the code.

CMS classifies 27886 as an inpatient-only procedure (status indicator C under HOPD rules), which means it cannot be paid under the Hospital Outpatient Prospective Payment System when billed on a facility claim. The 90-day global period attaches to this code, so any return to the OR within that window for a related complication — flap necrosis, bone revision, wound dehiscence — must carry modifier 78. A staged higher-level conversion (e.g., BKA to AKA) within the global is modifier 79 if unrelated to the re-amputation itself, or modifier 58 if it was planned.

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 (9.77) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (18.02) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	9.77
Practice expense RVU	5.89
Malpractice RVU	2.36
Total RVU	18.02
Medicare national rate	$601.88
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	$601.88
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 27886 get rejected.

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

Billed as outpatient/ASC facility claim — 27886 is inpatient-only under HOPD rules and will be rejected in that setting.
Missing documentation of a prior amputation stump, causing payer to question whether this is a re-amputation versus an initial BKA.
Global period conflict — return to OR for stump complication submitted without modifier 78, triggering a duplicate-service denial.
Operative note describes bone debridement or tibia-only resection without fibula involvement, creating a mismatch with the code's bilateral-bone requirement.
Modifier 58 omitted when procedure is a planned staged conversion from guillotine amputation closure, prompting denial as unbundled from 27882/27884.

Frequently asked questions

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

01What is the difference between CPT 27884 and 27886?

CPT 27884 covers formal closure or additional bone resection following a guillotine-type open amputation — typically a staged second procedure after emergent 27882. CPT 27886 is for patients with a prior closed BKA stump who require re-amputation at a higher tibial/fibular level due to ischemia, infection, or wound failure. The key distinction: 27884 follows a guillotine; 27886 follows a closed stump.

02Can 27886 be performed in an ASC or outpatient hospital setting?

No. CMS classifies 27886 as an inpatient-only procedure under the Hospital Outpatient Prospective Payment System. A facility claim billed in the HOPD or ASC setting will be denied. The procedure must be performed and billed in the inpatient hospital setting.

03Which modifier applies if the re-amputation is performed during the global period of the original BKA?

Use modifier 78 if the re-amputation is an unplanned return to the OR for a complication related to the original procedure. Use modifier 58 if it was a planned staged procedure. Use modifier 79 if the re-amputation is genuinely unrelated to the index procedure — though that scenario is uncommon given the clinical context.

04What if the surgeon only cut the tibia and not the fibula — is 27886 still correct?

The code description specifies resection through both tibia and fibula. If only the tibia was cut, the operative note deviates from the standard code description. Modifier 52 has been discussed in the coding community for this scenario, but it requires strong documentation of why only one bone was resected. Alternatively, some coders evaluate whether 11044 (bone debridement) better fits the work performed.

05Does the 90-day global period for 27886 include post-op wound care and stump dressings?

Yes. The 90-day global covers routine post-op visits, wound checks, dressing changes, and suture or staple removal through day 90. Anything unrelated to the re-amputation billed in that window needs modifier 24 (E/M) or modifier 79 (procedure). A new complication requiring return to the OR is modifier 78.

06If a BKA patient requires conversion to an above-knee amputation, is that still 27886?

No. CPT 27886 applies when a low BKA is converted to a high BKA — same bones, higher level. When a BKA is converted to an above-knee amputation (through the femur), report 27590 or 27591 for the AKA. Within the global of the original BKA, append modifier 78 if unplanned or modifier 58 if staged.

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 prior amputation level, bones resected (tibia, fibula, or tibia only), indication for revision (ischemia, infection, necrosis), flap technique, and closure method directly from dictation. That detail prevents the most common denial trigger — an operative note that doesn't distinguish a re-amputation from an initial BKA or a bone debridement, which auditors and payers flag immediately.

See how Mira captures CPT 27886 documentation