CPT 27386: Secondary Repair of Quadriceps or Hamstring with Autograft - OpenPayer

Summary & Overview

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.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 27386muscle repairquadricepshamstringsecondary reconstructionautograftorthopedic surgerysurgical codingambulatory surgery

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.

Service type: Surgical secondary muscle reconstruction involving graft harvest and repair of quadriceps or hamstring muscle tears.
Typical site of service: Hospital outpatient department or inpatient operating room, and ambulatory surgery center depending on clinical complexity and patient status.

Clinical & Coding Specifications

Clinical Context

A 42-year-old recreational athlete sustained a proximal quadriceps tendon avulsion during a fall while playing soccer. Initial conservative management and attempted primary repair at an outside facility were unsatisfactory, and persistent weakness, pain, and a palpable defect persisted several weeks after injury. The orthopedic surgeon evaluates the patient in clinic, reviews prior operative notes and imaging (MRI demonstrating retracted quadriceps musculotendinous junction), obtains preoperative clearance, and schedules a secondary reconstruction using autograft fascia lata or hamstring tendon to bridge the defect.

The clinical workflow includes: preoperative evaluation and informed consent; review of prior imaging and operative reports; anesthesia assessment (general or regional); operative harvesting of autograft (for example, ipsilateral fascia lata or semitendinosus tendon); reconstruction of the quadriceps or hamstring muscle-tendon unit with graft fixation; intraoperative assessment of tension and range of motion; layered closure and postoperative immobilization or bracing. Postoperative care involves routine surgical follow-up, wound checks, pain control, and staged physical therapy focusing on protected range of motion followed by progressive strengthening.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the secondary reconstruction requires substantially greater work than typical due to extensive scar tissue, multiple graft harvest sites, or complex revisions.

CPT 27390: Open Tenotomy of Single Hamstring Tendon

cpt-27397-thigh-tendon-transfer-multiple-tendons

CPT 27397: Thigh Multiple Tendon Transfer

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

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

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

CPT 27424: Patellectomy for Dislocating Patella

cpt-27394-hamstring-tendon-lengthening-unilateral

CPT 27394: Hamstring Tendon Lengthening, Unilateral

cpt-27465-femoral-shortening-surgery-leg-length-discrepancy

CPT 27465: Femoral Shortening Surgery for Leg Length Discrepancy

cpt-27499-fasciotomy-thigh-knee-debridement

CPT 27499: Fasciotomy of Thigh/Knee with Debridement

cpt-27420-patellar-tendon-transfer-bone-block

CPT 27420: Patellar Tendon Transfer with Bone Block

cpt-27396-thigh-tendon-transfer

CPT 27396: Thigh Muscle Tendon Transfer

cpt-27497-thigh-knee-fasciotomy-with-debridement

CPT 27497: Thigh/Knee Fasciotomy with Debridement

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Taxonomy Code	Specialty	Notes
207L00000X	Orthopaedic Surgery	Primary specialty performing secondary quadriceps/hamstring reconstructions.
2080P0207X	Sports Medicine (Orthopaedic)	Specialists focusing on athletic injuries and complex muscle-tendon repairs.
2085S0010X	Orthopaedic Trauma	Surgeons managing revisions and complex reconstructions after failed primary repairs.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S76.021A`	Strain of muscle, fascia and tendon of the right thigh, initial encounter	Acute quadriceps muscle/tendon injuries leading to secondary reconstruction when initial management fails.
`S76.022A`	Strain of muscle, fascia and tendon of the left thigh, initial encounter	Left-sided equivalent; relevant when reconstruction is performed on the left limb.
`S76.11XA`	Strain of hamstring muscle, fascia and tendon of right thigh, initial encounter	Hamstring tears that may require secondary reconstruction when there is significant retraction or failed primary repair.
`S76.12XA`	Strain of hamstring muscle, fascia and tendon of left thigh, initial encounter	Left-sided hamstring injuries leading to secondary reconstruction.
`M66.861`	Spontaneous rupture of right quadriceps tendon	Indicates delayed or secondary repair context when rupture was not adequately repaired initially.
`M66.862`	Spontaneous rupture of left quadriceps tendon	As above for the left side.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`20680`	Removal of implant; deep (e.g., buried wires, pins, screws, metal band) when performed	May be performed prior to or during secondary reconstruction if prior fixation hardware is present and needs removal to access the repair site.
`20930`	Allograft, large, structural, for knee or other joint — includes processing, when used	Used when an allograft tendon or fascia is selected instead of autograft for reconstruction.
`23420`	Repair of quadriceps tendon, acute (primary repair)	Represents the primary repair code; useful for comparison and identifying that `27386` is a secondary reconstruction rather than an acute primary repair.
`27130`	Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip)	Data not typically related but included only if concomitant hip procedures are performed (if unrelated, use appropriate modifier).
`29881`	Arthroscopy, knee, surgical; with meniscal repair	Performed in the same operative session if intra-articular pathology is addressed concurrently with muscle reconstruction.

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