CPT 27097 Proximal Hamstring Release Reimbursement | OpenPayer

Summary & Overview

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.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare27097CPThamstring releasesoft-tissue surgeryorthopedicsambulatory surgeryoperative proceduremusculoskeletal

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.

CPT 27100: External Oblique Transfer to Greater Trochanter

CPT-27156-PELVIC-AND-FEMORAL-OSTEOTOMY-HIP-REDUCTION

CPT 27156: Pelvic and Femoral Osteotomy with Hip Reduction

CPT-27098-ADDUCTOR-TENDON-TRANSFER-ISCHIAL-REATTACHMENT

CPT 27098: Adductor Tendon Transfer to Ischium

CPT-27125-FEMORAL-HEAD-REPLACEMENT-HEMIARTHROPLASTY-STABILIZATION

CPT 27125: Femoral Head Replacement (Hemiarthroplasty) for Stabilization

CPT-27185-TROCHANTERIC-EPIPHYSIODESIS-GROWTH-MODULATION

CPT 27185: Trochanteric Epiphysiodesis for Proximal Femoral Growth Modulation

27130-ARTHROPLASTY-ACETABULAR-AND-PROXIMAL-FEMORAL-PROSTHETIC

CPT 27130: Total Hip Arthroplasty (Acetabular and Femoral Prosthetic Replacement)

CPT-27122-ACETABULOPLASTY-AND-FEMORAL-HEAD-RESECTION

CPT 27122: Acetabuloplasty with Femoral Head Resection

CPT-27177-OPEN-FIXATION-SLIPPED-FEMORAL-EPIPHYSIS

CPT 27177: Open Fixation for Slipped Femoral Epiphysis

CPT-27181-INTERTROCHANTERIC-OSTEOTOMY-SLAP-FEMORAL-EPIPHYSIS-INTERNAL-FIXATION

CPT 27181: Intertrochanteric Osteotomy for Slipped Femoral Epiphysis with Fixation

CPT-27137-HIP-ACETABULAR-COMPONENT-REVISION

CPT 27137: Revision Hip Arthroplasty, Acetabular Component

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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.

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