CPT 27385: Hamstring or Quadriceps Primary Rupture Repair - OpenPayer

Summary & Overview

CPT 27385: Hamstring or Quadriceps Primary Rupture Repair

CPT code 27385 denotes surgical suturing of a primary rupture of the hamstring or quadriceps muscle to relieve pain and restore an appropriate gait. This procedure is clinically significant for patients with acute traumatic or degenerative muscle ruptures that impair mobility and function. Nationally, accurate coding of CPT code 27385 affects surgical case capture, quality measurement around musculoskeletal repair, and payment for operative services.

Key payers in scope include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise clinical context for when the procedure is used, typical sites of service, and an outline of common billing considerations. The publication summarizes benchmarks where available, highlights recent policy updates that impact operative musculoskeletal billing, and clarifies documentation elements relevant to coding and claim adjudication.

This executive summary serves providers, coding professionals, and payer policy analysts seeking a national-level reference on clinical intent, service setting, and payer coverage relevance for CPT code 27385.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 27385hamstring repairquadriceps repairorthopedic surgerymusculoskeletal procedureoperative codingsurgical suturingambulatory surgeryhospital inpatient

Billing Code Overview

CPT code 27385 describes surgical repair by suturing of a primary rupture of the hamstring or quadriceps muscles. The procedure is performed to relieve pain and restore functional gait by reapproximating torn muscle tissue.

Service type: Surgical musculoskeletal procedure (open repair of major thigh muscle rupture)
Typical site of service: Hospital operating room or ambulatory surgical center, depending on clinical severity and perioperative needs

Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.

Clinical & Coding Specifications

Clinical Context

A 42-year-old recreational runner presents with an acute onset of posterior thigh pain after a sprint, inability to bear weight on the affected leg, and palpable gap in the muscle belly. Examination and MRI confirm a complete proximal hamstring tendon rupture. The surgical team schedules an operative repair to suture the primary rupture of the hamstring to restore muscle continuity, reduce pain, and reinstate gait mechanics.

The clinical workflow includes: preoperative evaluation with history, focused musculoskeletal exam, imaging confirmation (MRI), informed consent, operative scheduling in an ambulatory surgery center or hospital operating room, general or regional anesthesia, open or mini-open repair of the ruptured hamstring with suture fixation to tendon or bone as indicated, postoperative immobilization and pain control, and coordinated physical therapy for progressive weight bearing and strengthening. Typical length of stay is same-day discharge from an ambulatory surgery center or overnight observation if inpatient care is required.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the repair requires substantially greater work or complexity than usual (extensive debridement, atypical exposure).

CPT 27495: Femoral Defect Fixation with Internal Implants

cpt-27472-femur-nonunion-malunion-repair-with-bone-graft

CPT 27472: Repair of Femur Nonunion or Malunion with Bone Graft

cpt-27395-hamstring-tendon-lengthening-bilateral

CPT 27395: Hamstring Tendon Lengthening, Bilateral

cpt-27429-knee-ligament-reconstruction-intra-extra-articular

CPT 27429: Reconstruction of Intra- and Extra-Articular Knee Ligaments

cpt-27441-tibial-reconstruction-debridement-partial-synovectomy-knee

CPT 27441: Tibial Reconstruction with Debridement and Partial Synovectomy

cpt-27498-lower-extremity-compartment-fasciotomy-thigh-knee

CPT 27498: Fasciotomy of Multiple Compartments, Thigh and/or Knee

27447

CPT 27447: Total Knee Arthroplasty (Complete Knee Replacement)

cpt-27424-patellectomy-surgical-removal-of-patella

CPT 27424: Patellectomy for Dislocating Patella

27446

CPT 27446: Partial Knee Arthroplasty, Medial or Lateral Compartment

cpt-27394-hamstring-tendon-lengthening-unilateral

CPT 27394: Hamstring Tendon Lengthening, Unilateral

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Taxonomy Code	Specialty	Notes
2080P0206X	Orthopaedic Surgery	Orthopaedic surgeons commonly perform hamstring or quadriceps tendon repairs.
207X00000X	General Surgery	General surgeons with orthopaedic training may perform soft-tissue repairs in trauma settings.
2086S0123X	Sports Medicine (Orthopaedic)	Sports medicine specialists perform operative tendon repairs focusing on return-to-sport rehabilitation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S76.21XA`	Strain of muscle, fascia and tendon of right hamstring, initial encounter	Represents acute hamstring muscle/tendon injury indicating primary repair.
`S76.22XA`	Strain of muscle, fascia and tendon of left hamstring, initial encounter	Left-sided acute hamstring injury requiring repair.
`S76.01XA`	Contusion of right hip and thigh, initial encounter	Associated traumatic contusions that can accompany hamstring rupture.
`M66.861`	Spontaneous rupture of muscle, right thigh	Captures nontraumatic muscle ruptures when repair is indicated.
`S76.23XA`	Strain of muscle, fascia and tendon of unspecified hamstring, initial encounter	Use when laterality unspecified at initial coding.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27370`	Repair, primary, ruptured quadriceps tendon, with or without graft	Often performed for proximal quadriceps tendon ruptures; similar repair technique when quadriceps rather than hamstring is involved.
`29881`	Arthroscopy, knee, surgical; meniscectomy (medial or lateral including any meniscal shaving)	Performed concurrently if intra-articular knee pathology is present and addressed during the same operative session.
`27096`	Repair of proximal hamstring avulsion; open or percutaneous (note: code for partial or other approaches)	Related repair code for hamstring avulsions; may be used depending on repair site and technique.
`20550`	Injection(s); single tendon sheath, ligament, or muscle	Used preoperatively or postoperatively for diagnostic or therapeutic injections when indicated.
`99223`	Initial hospital care, typically 70 minutes or more	Represents inpatient evaluation when the patient requires inpatient admission for perioperative medical management.

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