Summary & Overview
CPT 27395: Hamstring Tendon Lengthening, Bilateral
CPT code 27395 denotes surgical lengthening of multiple hamstring tendons from the knee to the hip. This procedure addresses hamstring contractures or severe tightness that impair gait, knee flexion, or hip extension, and it can be performed in pediatric and adult populations depending on clinical indication. Nationally, procedures addressing musculoskeletal contractures are relevant due to impacts on mobility, rehabilitation needs, and surgical resource use.
Payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The content outlines clinical context for use of CPT code 27395, common settings where the procedure is delivered, and what readers can expect when reviewing payer coverage and reimbursement materials. It summarizes benchmarks where available, highlights relevant policy considerations such as coverage criteria and site-of-service distinctions, and provides clinical context for coding and documentation.
Readers will learn the clinical intent of the code, typical sites of service, payer landscape included in the review, and what types of documentation and coding considerations are commonly associated with hamstring tendon lengthening procedures. Data not available in the input will be noted as such in detailed sections.
Billing Code Overview
CPT code 27395 describes a surgical procedure in which a provider lengthens multiple hamstring tendons from the knee to the hip by incising the tendons. The hamstring muscle group includes the biceps femoris, semitendinosus, and semimembranosus, which function to bend the knee and extend the thigh posteriorly. This procedure is performed to address hamstring tightness or contracture affecting lower-extremity function.
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Service type: Surgical tendon lengthening of the hamstrings
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Typical site of service: Operating room or surgical suite in an inpatient or outpatient hospital setting, or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A typical patient is an adolescent or adult with bilateral hamstring contractures causing limited knee extension, gait abnormality, or functional impairment. The patient often presents after conservative measures (physical therapy, stretching, orthotics, botulinum toxin) have failed to provide adequate range of motion or symptom relief. Preoperative evaluation includes history, physical exam documenting decreased knee extension and popliteal angle, imaging as indicated (radiographs or MRI to evaluate tendon pathology or bone deformity), and anesthesia assessment.
The clinical workflow begins with preoperative consent and marking of bilateral lower extremities. On the day of surgery the patient undergoes general or regional anesthesia. The surgeon makes longitudinal or transverse incisions along the posterior thigh and identifies the hamstring complex (biceps femoris, semitendinosus, semimembranosus). Multiple tendon lengthening techniques (Z-plasty or transverse release) are performed from knee to hip as indicated to restore knee extension. Hemostasis and layered closure are performed; dressings and immobilization or orthosis are applied. Postoperative plan includes pain control, wound checks, physical therapy with progressive range-of-motion and strengthening, and follow-up visits to monitor healing and gait improvement.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
50 | Bilateral procedure | Use when 27395 is performed on both legs and payer requires bilateral modifier instead of separate line items. |
RT | Right side | Use when documenting the procedure performed on the right lower extremity if billed separately. |
LT | Left side | Use when documenting the procedure performed on the left lower extremity if billed separately. |
22 | Increased procedural services | Use when work or complexity substantially exceeds the typical service for 27395 and documentation supports unusual service. |
52 | Reduced services | Use when the procedure is partially reduced or abbreviated and documentation supports less than full service. |
53 | Discontinued procedure | Use when the procedure was started but terminated due to extenuating circumstances prior to completion. |
62 | Two surgeons | Use when two surgeons work together as primary surgeons performing distinct portions of 27395. |
66 | Surgical team technique | Use when the procedure is performed using a documented surgical team approach. |
78 | Unplanned return to operating room | Use when the patient returns to the OR for a related procedure during the global period for 27395. |
79 | Unrelated procedure or service during the postoperative period | Data not available in the input. |
76 | Repeat procedure by same physician | Data not available in the input. |
77 | Repeat procedure by another physician | Data not available in the input. |
23 | Unusual anesthesia | Use when 27395 is performed under general anesthesia when regional or local is normally used and documentation supports the reason. |
26 | Professional component | Use when billing only the professional component of a service related to 27395 (rare for pure surgical codes). |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
2080P0207X | Orthopaedic Surgery | Orthopaedic surgeons commonly perform hamstring lengthening for contractures. |
208100000X | Family Medicine | In some settings family medicine with additional surgical training may coordinate care or perform procedures in rural settings. |
2086S0105X | Pediatric Orthopedics | Pediatric orthopedic surgeons perform hamstring lengthening for neuromuscular conditions in children. |
207LN0002X | Physical Medicine & Rehabilitation | PM&R physicians manage perioperative rehabilitation and may perform select procedures in multidisciplinary settings. |
208000000X | General Surgery | General surgeons rarely perform complex lower-extremity tendon procedures but may be involved in trauma settings. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M62.4 | Contracture of muscle | Documents hamstring muscle contracture that may necessitate surgical lengthening to improve range of motion. |
M24.2 | Recurrent dislocation and subluxation of joint | Used when recurrent knee instability and associated soft-tissue tightness contribute to functional impairment addressed by lengthening. |
G81.90 | Hemiplegia, unspecified affecting unspecified side | Neuromuscular conditions such as hemiplegia can produce hamstring contractures treated with lengthening procedures. |
G80.9 | Cerebral palsy, unspecified | Cerebral palsy commonly causes spastic hamstring contractures in children for which 27395 is performed. |
M75.50 | Bursitis of unspecified shoulder (site applied as an example) | Data not available in the input. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
20610 | Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., shoulder, hip, knee) | May be performed preoperatively for diagnostic or therapeutic relief of joint effusion contributing to limited motion. |
29515 | Application of multi-component lower-extremity orthosis, knee-ankle-foot orthosis, prefabricated, includes fitting and adjustment | Used postoperatively for immobilization or gait assistance after hamstring lengthening. |
27495 | Arthrotomy with exploration, drainage, or synovectomy, knee | May be performed in the same episode if intra-articular pathology requiring open intervention is present. |
27650 | Repair, primary, traumatic injuries of tendon (e.g., Achilles) | Related tendon procedures on the posterior thigh or leg; listed when additional tendon repair is necessary during the same surgical session. |
99024 | Postoperative follow-up visit, normally included in the global period; discretional reporting for reporting purposes | Used for documenting postoperative global period visits when payer-specific reporting is required. |