Surgical removal of the foot by separating it from the lower leg at the ankle joint, preserving the heel pad for a weight-bearing residual limb.

Verified May 8, 2026 · 5 sources ↓

Medicare: $597.54
Work RVU: 10.59
Global, days: 90
Region: Foot & ankle

Drawn from CMSAAPCGenhealth

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Clearly state that the amputation was performed through the ankle joint, not through bone (transtibial level)
Document preservation of the heel pad and its attachment to the residual stump for weight-bearing
Record the primary indication — infection, gangrene, peripheral arterial disease, or trauma — with supporting clinical findings
Include pre-operative imaging or vascular studies supporting non-salvageability of the foot
Document anesthesia type (general or spinal) and intraoperative hemostasis technique
Note wound closure method and condition of the residual limb at end of case

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 27889 describes ankle disarticulation — the surgical amputation of the foot through the ankle joint without cutting bone. The surgeon disarticulates at the tibiotalar joint and preserves the heel pad, which is then anchored to the stump to create a weight-bearing surface. This is the defining feature that distinguishes ankle disarticulation (27889) from transtibial amputation through bone. The procedure is commonly performed for nonhealing diabetic wounds, peripheral arterial disease with gangrene, severe infection, or traumatic injury that renders the foot unsalvageable.

The 90-day global period means the surgeon's fee covers all routine postoperative care through day 90 — wound checks, suture removal, stump dressing changes, and standard follow-up. Services unrelated to the amputation billed within the global window require modifier 24 (E/M) or 79 (unrelated procedure). Planned staged procedures — such as a revision of the residual limb — use modifier 58. Unplanned returns to the OR for complications related to the amputation use modifier 78.

Code selection hinges on the level of amputation: 27889 is ankle disarticulation; 27888 covers amputation through the malleoli of the tibia and fibula (e.g., Syme, Pirogoff type); 27882 is amputation of the leg below the knee with immediate fitting of prosthesis. Document the exact joint level and technique to justify 27889 over adjacent codes.

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 (10.59) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (17.89) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	10.59
Practice expense RVU	5
Malpractice RVU	2.3
Total RVU	17.89
Medicare national rate	$597.54
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	$597.54
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 27889 get rejected.

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

Wrong-level coding — op note describes bone transection, which maps to 27882 or 27888, not 27889
Missing or vague indication documentation — payers require explicit diagnosis linking tissue non-viability or trauma to medical necessity for amputation
Global period conflict — separate E/M or minor procedure billed within the 90-day window without modifier 24 or 79
Unbundling of wound closure, hemostasis, or casting codes that are included in the surgical package
Site-of-service mismatch — procedure billed under facility place of service but professional claim lacks consistent setting documentation

Frequently asked questions

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

01What is the difference between CPT 27889 and 27888?

27889 is true ankle disarticulation — the foot is removed at the tibiotalar joint, no bone is cut. 27888 covers amputation through the malleoli of the tibia and fibula (Syme or Pirogoff type), which involves transecting bone. The operative note must specify the exact level; auditors will recode 27889 to 27888 if bone transection is documented.

02What global period applies to 27889?

90-day global. All routine post-op visits, wound care, dressing changes, and stump monitoring from the day before surgery through day 90 are bundled into the surgical fee. Unrelated E/M services in that window need modifier 24.

03Can 27889 be billed with a residual limb revision in the same global period?

Yes, but the modifier determines relatedness. If the revision is a planned staged procedure, use modifier 58. If the patient returns urgently for a complication directly related to the amputation (e.g., wound dehiscence requiring OR return), use modifier 78. An unrelated procedure on the same limb or elsewhere uses modifier 79.

04Is 27889 appropriate for bilateral amputations?

Bilateral ankle disarticulation performed in a single session is extremely uncommon but codable. In a facility setting, report on two claim lines with modifiers LT and RT. In an ASC, follow the same two-line approach; the 50% reduction rule for bilateral procedures applies per CMS NCCI policy.

05What ICD-10 diagnoses support medical necessity for 27889?

Common supporting diagnoses include diabetic foot infection with osteomyelitis, peripheral arterial occlusive disease with gangrene, necrotizing fasciitis, and traumatic crush injury of the foot or ankle. The diagnosis must document non-salvageability — vague codes like 'foot pain' will trigger medical necessity denials.

06Does CPT 27889 include casting or dressing application?

Yes. Postoperative wound dressings and initial casting or splinting applied at the time of surgery are bundled into the global surgical package. Do not separately bill casting or strapping codes for the operative encounter.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the exact level of amputation (ankle joint disarticulation, not transosseous), heel pad preservation and attachment technique, primary indication with supporting clinical findings, and intraoperative hemostasis and closure detail — all from surgeon dictation. That prevents the most common audit flag for 27889: an op note that doesn't distinguish joint disarticulation from bone-level transection, which triggers downcoding to 27882 or 27888.

See how Mira captures CPT 27889 documentation