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.
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.
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Service type: Surgical musculoskeletal procedure (open repair of major thigh muscle rupture)
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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). |
52 | Reduced services | Use when the procedure is partially reduced or not completed at the physician's discretion. |
53 | Discontinued procedure | Use when the repair is started but halted for patient safety or unexpected findings. |
62 | Two surgeons | Use when two surgeons of different specialties perform distinct portions of the repair. |
80 | Assistant surgeon | Use when a surgical assistant performs part of the operation. |
62 | Co-surgeon (alternate - note: 62 already listed) | Use when two surgeons work together surgically; code appears once in billing systems. |
59 | Distinct procedural service | Use to indicate a separate and distinct service when multiple procedures are billed on the same day (e.g., concurrent tendon repair at separate sites). |
76 | Repeat procedure by same physician | Data not provided; not listed in raw modifiers. Data not available in the input. |
78 | Return to OR for a related procedure during the postoperative period | Use when a complication requires reoperation for the same hamstring repair. |
79 | Unrelated procedure or service by the same physician during the postoperative period | Use when an unrelated surgical procedure is performed during the global period. |
RT | Right side | Use to indicate the procedure was performed on the right leg. |
LT | Left side | Use to indicate the procedure was performed on the left leg. |
QX | Modifier for assistant surgeon requirements (specific to advanced practitioners) | Use when a qualified non-physician assistant performs designated assistant services under supervision and billing rules. |
XS | Separate structure, distinct service | Use to indicate a procedure performed on a separate anatomical site. |
| 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. |