Ankle-level amputation through the malleoli of the tibia and fibula, with nerve resection and plastic closure of the soft tissue envelope to create a functional stump — classically the Syme or Pirogoff technique.

Verified May 8, 2026 · 6 sources ↓

Medicare: $533.08
Work RVU: 10.11
Global, days: 90
Region: Foot & ankle

Drawn from AAPCMdclarityGenhealthNIHCMS

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 must specify the level of bone section — through the malleoli of tibia and fibula — and the named technique (Syme, Pirogoff, or other variant)
Document nerve identification, resection length, and burial or ligation method to support neuroma prevention and justify complexity
Plastic closure technique must be described: flap design, heel pad mobilization, and layered closure — supports the plastic closure component of 27888 versus a simpler amputation code
Pre-operative vascular or wound assessment documenting limb-threatening condition (ABI, wound culture, imaging, or vascular surgery consult note) to establish medical necessity
Laterality must be recorded explicitly in the operative note and on the claim (LT or RT modifier)
Post-operative plan including prosthetics referral and rehabilitation intent, supporting functional outcome documentation required by many payers

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 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 27888 covers amputation at the ankle joint performed through the bony prominences (malleoli) of the tibia and fibula. The surgeon resects the foot, divides and buries peripheral nerves to reduce neuroma risk, and performs plastic closure to shape the residual limb for prosthetic fitting and end-bearing weight. The Syme amputation — the most common variant — preserves the heel pad and positions it beneath the tibia, allowing limited ambulation on the stump. The Pirogoff technique is a less common alternative that retains a portion of the calcaneus.

The procedure carries a 90-day global period. All routine post-op visits, wound checks, and dressing changes within that window are bundled — unbundling them triggers recoupment. Bill unrelated procedures during the global with modifier 79; an unplanned return to the OR for a related complication (e.g., flap revision) uses modifier 78. If a staged revision was planned and documented at the time of the original surgery, use modifier 58.

The primary indications are non-healing diabetic foot wounds, critical limb ischemia with gangrene, and severe crush injury where distal salvage is not viable. ICD-10 diagnosis codes must clearly support limb-threatening pathology — vague wound or ulcer codes without severity or laterality are a top denial trigger. Always append LT or RT; bilateral ankle amputation is exceptionally rare but would use modifier 50 per professional claim conventions.

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 (10.11) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (15.96) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	10.11
Practice expense RVU	3.27
Malpractice RVU	2.58
Total RVU	15.96
Medicare national rate	$533.08
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	$533.08
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 27888 get rejected.

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

Missing or vague ICD-10 diagnosis — wound or ulcer codes without severity staging or laterality fail medical necessity review
Laterality modifier absent (LT or RT) — Medicare and most commercial payers reject ankle-level amputation claims without a side designation
Unbundled post-op visits billed without modifier 24 or 25 inside the 90-day global period
Operative note does not distinguish 27888 from adjacent codes (27882 below-knee amputation, 27889 ankle disarticulation) — missing malleoli-level bone section documentation causes downcoding
Modifier 78 or 79 omitted on a return-to-OR claim during the global period, resulting in automatic denial as duplicate or global-included service

Frequently asked questions

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

01What is the difference between CPT 27888 and CPT 27889?

27888 is amputation through the malleoli of the tibia and fibula with plastic closure and nerve resection — the Syme or Pirogoff technique. CPT 27889 describes ankle disarticulation, a through-joint amputation that does not section bone at the malleolar level. The operative note must specify which bony anatomy was cut to support the correct code.

02Does 27888 require modifier LT or RT?

Yes. Medicare and most commercial payers require a laterality modifier on every single-extremity procedure. Submit LT or RT on every 27888 claim. Missing laterality is one of the fastest paths to a denial that can't be appealed without an amended operative note.

03What global period applies to 27888?

90-day global. The operative day, the day before surgery if a pre-op visit occurred, and all routine post-op care through day 90 are bundled. Use modifier 24 for unrelated E/M visits in that window, modifier 78 for an unplanned return to the OR for a related complication, and modifier 79 for an unrelated procedure.

04Can 27888 be billed bilaterally?

Bilateral ankle amputation is clinically rare but billable. On a professional claim, report one line with modifier 50. Per NCCI policy, an ASC should report two lines — one with LT and one with RT — each with one unit of service.

05What ICD-10 diagnoses support medical necessity for 27888?

Critical limb ischemia with gangrene, non-healing diabetic foot ulcer with osteomyelitis or bone involvement, and severe open traumatic injury are the primary supporting diagnoses. Stage and laterality must be captured — unspecified ulcer or wound codes without severity indicators are the leading reason payers deny medical necessity on amputation claims.

06When is modifier 58 appropriate with 27888?

Use modifier 58 when a staged revision — such as a planned revision amputation or flap revision — was documented as anticipated at the time of the original 27888 surgery. If the return to the OR was unplanned and for a related reason, modifier 78 applies instead. Using 78 when 58 is correct (or vice versa) triggers payment delays and audit flags.

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 amputation level (through the malleoli of tibia and fibula), the named procedure variant (Syme or Pirogoff), nerve resection detail, heel pad handling, and plastic closure technique directly from dictation — then flags if laterality is missing before the note is finalized. That prevents the two most common 27888 denials: an operative note that can't distinguish this code from 27882 or 27889, and a claim submitted without LT or RT.

See how Mira captures CPT 27888 documentation