Summary & Overview
CPT 27635: Excision of Benign Bone Lesion, Tibia or Fibula
CPT code 27635 covers surgical excision of a bone cyst or benign tumor from the tibia or fibula. This orthopedic procedure matters nationally because it addresses pain control and infection prevention for benign lower leg bone lesions, conditions that can affect mobility and require timely surgical management. Payers and providers rely on accurate coding for appropriate coverage determinations, facility placement, and surgical care pathways.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure and an explanation of typical sites of service. The publication outlines benchmarking considerations, common billing and coverage touchpoints, and policy-relevant topics that influence payment and utilization for lower-extremity bone lesion excision. Where payer-specific policies exist, the piece clarifies how coverage and site-of-service guidance can differ across commercial plans and Medicare.
This summary equips healthcare administrators, coding professionals, and orthopedic clinicians with a clear description of the service represented by CPT code 27635, what to expect for site-of-service designation, and which national payers commonly govern payment and authorization processes. Data not available in the input will be noted where applicable in the main publication.
Billing Code Overview
CPT code 27635 describes the surgical removal of a bone cyst or benign tumor from the tibia or fibula. This procedure is performed to prevent local infection and to relieve pain associated with the lesion.
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Service type: Surgical excision of benign bone lesion
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Typical site of service: Hospital operating room or ambulatory surgical center for orthopedic surgery
Clinical & Coding Specifications
Clinical Context
A 28-year-old patient presents with progressive anterior tibial pain and a palpable, tender swelling over the midshaft of the tibia. Imaging (radiograph and MRI) demonstrates a unilocular, well-circumscribed benign bone cyst within the proximal tibial metaphysis without pathologic fracture but with cortical thinning and persistent pain despite conservative management. The orthopedic surgeon schedules an operative cyst excision (curettage) with possible bone grafting. The patient arrives to an ambulatory surgery center on the day of surgery after preoperative evaluation. Under regional or general anesthesia, the surgeon makes a small incision over the lesion, performs curettage and removal of the benign cystic lesion from the tibia, irrigates the defect, and places bone graft or bone substitute as indicated. Hemostasis is achieved and the wound is closed. Postoperative recovery includes short observation in PACU, multimodal analgesia, wound care instructions, weight-bearing restrictions if grafting performed, and outpatient orthopedic follow-up for wound check and radiographic monitoring for recurrence or healing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the work, time, or complexity substantially exceeds usual for 27635 (documentation required). |