CPT 27630 Reimbursement & Benchmarks | OpenPayer

Summary & Overview

CPT 27630: Excision of Tendon Sheath or Capsule Lesion, Leg/Ankle

CPT code 27630 covers surgical excision of a lesion (for example, a cyst or ganglion) from the tendon sheath or capsule in the leg and/or ankle to relieve pain and restore function. This procedure-level code is relevant across orthopedic and podiatric surgical practices and for payers managing musculoskeletal and ambulatory surgery benefits. Nationally, claims for lesion excision in the lower extremity affect outpatient surgical utilization, prior authorization workflows, and payment policy for soft-tissue procedures.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for the procedure, common care settings, and typical service lines. The publication summarizes benchmarking elements commonly used for this code, highlights policy and coverage considerations that influence utilization and billing, and describes clinical indications tied to symptom relief and functional improvement.

This summary is intended for billing managers, coding professionals, clinical leaders, and payers seeking a concise reference to CPT code 27630, its clinical role, and the payer landscape that shapes authorization and reimbursement practices. Data not available in the input has been noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 27630tendon sheath excisionankle surgeryleg lesion removalorthopedicspodiatryambulatory surgeryprocedure coding

Billing Code Overview

CPT code 27630 describes the surgical removal of a lesion, such as a cyst or ganglion, from the tendon sheath or capsule in the leg and/or ankle. The procedure is performed to relieve pain and improve function by excising localized soft-tissue lesions that affect tendons or joint capsules.

Service type: Surgical excision of tendon sheath or capsule lesion
Typical site of service: Operating room or ambulatory surgery center; may also be performed in a procedure suite when clinically appropriate

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 42-year-old recreational runner presents with a progressively painful, palpable ganglion cyst adjacent to the posterior tibial tendon at the ankle causing catching and limited dorsiflexion. Conservative measures (activity modification, NSAIDs, and aspiration) failed to relieve pain and restore function. The orthopedic foot and ankle surgeon evaluates the patient, documents size, location, neurovascular exam, and informed consent for excision of a tendon sheath or capsular lesion. Preoperative planning includes review of imaging (ultrasound or MRI to confirm lesion originating from the tendon sheath or joint capsule), anesthesia evaluation for regional block or general anesthesia, and marking the surgical site. In the operating room, the surgeon performs aseptic prep, makes a targeted incision over the lesion, dissects to the tendon sheath/capsule, excises the cyst or ganglion, achieves hemostasis, inspects tendon integrity, irrigates, closes in layers, and applies a sterile dressing and postoperative immobilization if indicated. Postoperative documentation includes operative note with CPT 27630 (excision, lesion from tendon sheath or capsule, leg/ankle), estimated blood loss, findings, specimens sent, and postoperative instructions for weightbearing, wound care, and follow-up for suture removal and physical therapy if needed.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component

CPT 27625: Ankle Synovectomy, Open Surgical Procedure

CPT-27616-EXTENSIVE-SOFT-TISSUE-TUMOR-RESECTION-LEG-ANKLE-5CM-OR-MORE

CPT 27616: Extensive Soft Tissue Tumor Resection, Leg or Ankle ≥5 cm

CPT-27626-ANKLE-TENDON-SHEATH-EXCISION-SYNOVECTOMY

CPT 27626: Excision of Ankle Tendon Sheath with Synovectomy

CPT-27632-SUBCUTANEOUS-TUMOR-EXCISION-3CM-OR-GREATER

CPT 27632: Excision of Subcutaneous Tumor ≥3 cm

CPT-27646-FIBULA-TUMOR-RESECTION-WIDE-MARGIN

CPT 27646: Fibula Tumor Resection with Wide Margins

CPT-27619-LEG-ANKLE-DEEP-SOFT-TISSUE-TUMOR-EXCISION-LT5CM

CPT 27619: Excision of Deep Soft-Tissue Tumor, Leg/Ankle (<5 cm)

CPT-27638-TIBIA-FIBULA-BONE-CYST-ALLOGRAFT

CPT 27638: Tibia/Fibula Bone Cyst Excision with Allograft

CPT-27641-FIBULA-RESECTION-FOR-OSTEOMYELITIS

CPT 27641: Fibula Resection for Osteomyelitis

CPT-27615-EXTENSIVE-EXCISION-SOFT-TISSUE-MASS-LEG-ANKLE-LESS-THAN-5CM

CPT 27615: Extensive Excision of Soft Tissue Tumor, Leg/Ankle (<5 cm)

CPT-27613-EXCISION-SKIN-LESION-LEG-ANKLE-PATHOLOGY

CPT 27613: Excision of Skin Lesion, Leg or Ankle

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Taxonomy Code	Specialty	Notes
`207L00000X`	Orthopedic Surgery	Foot and ankle surgeons commonly perform excision of tendon sheath or capsular lesions.
`207K00000X`	Podiatry	Podiatrists frequently manage and surgically excise ganglia/cysts of the ankle and foot.
`2080P0002X`	General Surgery	General surgeons occasionally perform lower extremity soft tissue excisions in some practice settings.
`207RR0500X`	Plastic Surgery	Plastic surgeons may perform excision for complex soft-tissue reconstruction or when repair requires flap coverage.
`365A00000X`	Anesthesiology	Anesthesia providers document regional or general anesthesia used for the procedure.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M67.4`	Ganglion, unspecified	Common benign cyst arising from tendon sheath or joint capsule; primary indication for excision with `CPT 27630`.
`M65.4`	Radial styloid tenosynovitis (de Quervain)	Tenosynovitis of a tendon sheath; similar pathology though at wrist—conceptually relevant as tendon sheath lesion.
`M65.3`	Trigger finger, not elsewhere classified	Involves tendon sheath pathology; included to capture sheath-related diagnoses though in upper extremity.
`M67.41`	Ganglion, right lower limb	Site-specific code when the ganglion is documented on the right leg/ankle.
`M67.42`	Ganglion, left lower limb	Site-specific code when the ganglion is documented on the left leg/ankle.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`20611`	Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., ankle)	Preoperative aspiration may be performed diagnostically or therapeutically for a cyst before deciding on excision.
`20526`	Injection, therapeutic, or diagnostic; tendon sheath, ligament, or ganglion cyst	Diagnostic or therapeutic injection/aspiration of a ganglion or tendon sheath prior to surgical excision; often performed in clinic.
`10120`	Incision and drainage of hematoma, seroma, or fluid collection	Performed if there is postoperative seroma or if intraoperative drainage of cyst contents is needed prior to definitive excision.
`12001`	Simple repair of superficial wounds of the scalp, neck, axillae, external genitalia, trunk and/or extremities	Closure of superficial skin incisions following excision when simple layered closure is used.
`20550`	Injection(s); tendon sheath, single or multiple trigger point	When corticosteroid injection is used as an adjunct therapy for tenosynovitis associated with the lesion; may be performed before or after excision.

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