CPT 27386: Secondary Repair of Quadriceps or Hamstring with Autograft
CPT code 27386 designates a surgical procedure for secondary repair of quadriceps or hamstring muscle tears using an autologous graft from tendon or fascia. This code applies when reconstruction occurs days after initial rupture or when a prior repair is unsatisfactory. Nationally, accurate use of 27386 affects surgical case mix reporting, reimbursement for complex soft-tissue reconstructions, and quality measurement for musculoskeletal surgical care.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes how 27386 is categorized for billing, common clinical settings where it is used (hospital outpatient departments, inpatient ORs, and ambulatory surgery centers), and implications for claims processing and utilization tracking.
Readers will find: concise clinical context for the procedure; benchmarks and payment considerations from major national payers; coding and documentation points relevant to secondary muscle reconstruction; and policy or coverage highlights that influence approval and reimbursement. Data not available in the input will be identified where relevant.
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Billing Code Overview
CPT code 27386 describes secondary repair of a quadriceps or hamstring muscle tear using an autograft taken from a tendon or fascial source. Secondary reconstruction denotes repair performed at least a few days after the initial muscle rupture or when an initial repair is not satisfactory.
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Service type: Surgical secondary muscle reconstruction involving graft harvest and repair of quadriceps or hamstring muscle tears.
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Typical site of service: Hospital outpatient department or inpatient operating room, and ambulatory surgery center depending on clinical complexity and patient status.