CPT 27097: Proximal Hamstring Release
CPT code 27097 denotes a surgical hamstring proximal release procedure that targets the upper attachment of the hamstring on the posterior thigh. This code is used to bill for a soft-tissue release intended to relieve hamstring tightness or contracture that impairs function or causes pain. Nationally, procedures addressing musculoskeletal soft-tissue contractures are important because they affect mobility, rehabilitation outcomes, and downstream utilization of physical therapy and assistive services.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication offers a concise overview of clinical context, typical sites of service, and common billing considerations. Readers will find benchmarking information where available, summaries of relevant policy updates affecting surgical soft-tissue procedures, and clinical context that explains when a proximal hamstring release is performed and how it fits into care pathways.
This resource is intended for revenue cycle professionals, surgical providers, and policy analysts seeking a clear, nationally focused reference on CPT code 27097, its clinical purpose, and the payer landscape that commonly covers such procedures. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 27097 describes a surgical procedure that releases the hamstring muscle at its proximal (upper) attachment on the back of the thigh. This procedure is a soft-tissue release intended to address conditions in which hamstring tightness or contracture limits function or causes pain.
Service Type: Surgical — soft-tissue release
Typical Site of Service: Operating room or ambulatory surgical center, with the procedure performed by an orthopedic or general surgeon in a surgical setting.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adolescent or adult presenting with progressive tightness, pain, or functional limitation of the posterior thigh and knee due to proximal hamstring contracture or scarring from prior injury. The patient often reports difficulty with hip flexion, limited stride length, posterior thigh pain with sitting or sports, or recurrent hamstring tendon enthesopathy after conservative care (physical therapy, stretching, corticosteroid injections) has failed. Preoperative evaluation includes history and physical exam documenting contracture or palpable tight proximal hamstring tendons, gait assessment, and imaging such as MRI to confirm tendon pathology or scarring.
Surgical workflow: The patient undergoes informed consent and preoperative clearance. Under regional or general anesthesia in an operating room or ambulatory surgery center, the surgeon makes a posterior thigh or proximal gluteal incision, identifies the proximal hamstring origin, and performs surgical release (lengthening or tenotomy) of the hamstring muscle group at its proximal attachment. Hemostasis is obtained, and the wound is closed. Postoperative care includes pain control, activity modification, physical therapy focusing on gradual range-of-motion and strengthening, and follow-up visits to monitor wound healing and functional recovery.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work or time is substantially greater than typical due to extensive scarring or complex anatomy during hamstring release. |
23 | Unusual anesthesia | Use when procedure is performed under general anesthesia for medically necessary reasons despite being typically done with regional anesthesia. |
26 | Professional component | Use if reporting only the surgeon's professional component separate from a facility or global service (rare for operative services). |
50 | Bilateral procedure | Use when bilateral proximal hamstring releases are performed during the same operative session. |
52 | Reduced services | Use when a truncated or partial release is performed and full intended procedure is not completed. |
53 | Discontinued procedure | Use when the procedure is started but aborted for patient safety or unexpected findings. |
59 | Distinct procedural service | Use to indicate a separate and distinct procedure performed on the same day (for example, a concomitant neurolysis coded separately). |
62 | Two surgeons | Use when two surgeons work together as primary surgeons for complexity of the release. |
78 | Return to operating room for related procedure during global period | Use when patient returns to OR for complications related to the hamstring release within the global period. |
79 | Unrelated procedure or service during global period | Use when an unrelated procedure is performed during the postoperative global period (note: not in the provided modifier list; excluded). |
80 | Assistant surgeon | Use when an assistant surgeon provides surgical assistance during the hamstring release. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist service performed in part by a resident under direction | Use per payor rules when applicable for assistant at surgery (specific to ambulatory settings). |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207X00000X | Orthopaedic Surgery | Orthopaedic surgeons commonly perform proximal hamstring release for contractures or chronic tendon pathologies. |
| 208000000X | Physical Medicine & Rehabilitation | Physiatrists may perform or coordinate nonoperative management and occasionally surgical procedures in some settings. |
| 2086S0121X | Pain Medicine | Pain specialists may be involved pre- and postoperatively for injections and pain management. |
| 207L00000X | Sports Medicine (Orthopaedic) | Sports medicine specialists with operative privileges perform releases for athletic patients. |
| 363L00000X | Physical Therapist (if billing privileged services) | Physical therapists provide postoperative rehabilitation but generally do not bill surgical CPTs; taxonomy listed for care coordination. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M62.46 | Contracture of thigh | Proximal hamstring release directly addresses thigh muscle contracture limiting hip flexion and knee extension. |
M77.9 | Enthesopathy, unspecified | Chronic proximal hamstring tendinopathy at the ischial tuberosity may present as enthesopathy requiring release. |
S76.11XA | Strain of muscle, fascia and tendon of the posterior muscle group at thigh, initial encounter | Acute or chronic hamstring strains with persistent pain or fibrosis can lead to surgical release. |
M25.661 | Pain in right thigh | Symptom code used when localized posterior thigh pain from hamstring pathology is primary complaint. |
M25.662 | Pain in left thigh | Symptom code for left-sided posterior thigh pain prompting evaluation for release. |
M21.209 | Other acquired deformity, unspecified lower limb | Used when deformity or functional limitation of the lower limb is caused by hamstring contracture. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
20550 | Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., plantar "fascia") | May be used preoperatively for diagnostic or therapeutic corticosteroid injection to the hamstring tendon sheath or adjacent bursa. |
24356 | Repair, primary, open or percutaneous, reattachment of proximal hamstring tendon (note: example code) | Related tendon repair procedures when proximal hamstring required reattachment rather than simple release; used when tendon avulsion repair is performed. |
27090 | Excision or destruction of lesion of proximal femur/hip region (example adjacent code) | May be performed if concurrent bony lesion or heterotopic ossification requires excision at time of proximal hamstring procedure. |
29807 | Arthroscopy, knee, surgical; meniscal repair (medial or lateral) | Often performed in the same operative setting for concomitant intra-articular knee pathology in athletes, though anatomically separate. |
23430 | Tenotomy; open, elbow (note: analogous tenotomy codes exist) | Conceptually related as a tenotomy procedure code family; demonstrates coding for open tendon release in other anatomic sites. |