Summary & Overview
CPT 27652: Achilles Tendon Repair with Graft
CPT code 27652 denotes surgical repair of an Achilles tendon rupture that includes placement of a graft to augment the repair. This code captures a more complex reconstructive approach compared with primary repair alone and is relevant for accurate procedural classification, appropriate reimbursement, and clinical documentation. Nationally, such repairs influence surgical case mix, resource utilization, and claims submissions for lower extremity orthopedic care.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the procedure and service context, common billing considerations, and the types of benchmarks and policy topics typically associated with this code. Content addresses clinical context for use of graft augmentation, expected sites of service (hospital inpatient, outpatient surgical center, ambulatory surgery center), and payer coverage themes.
This publication helps billing managers, coding professionals, and orthopedic clinicians understand where CPT code 27652 fits in procedural reporting and what operational and policy questions commonly arise, including documentation needs, site-of-service implications, and typical payer review points. Data not available in the input for specific modifiers, associated taxonomies, ICD-10 mappings, and related codes is explicitly noted where applicable.
Billing Code Overview
CPT code 27652 describes the surgical repair of an Achilles tendon rupture with placement of a graft. The procedure is performed to restore tendon continuity, recover ankle and foot function, and relieve pain associated with a ruptured Achilles tendon.
Service type: Surgical tendon repair with graft augmentation
Typical site of service: Hospital inpatient or outpatient surgical center, and may be performed in ambulatory surgical settings depending on clinical complexity and payer policies.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 38-year-old recreational runner presents to the orthopedic clinic after feeling a sudden pop in the posterior ankle while pushing off during a sprint. He reports immediate pain, swelling, and inability to plantarflex the foot against resistance. On exam there is a palpable gap above the calcaneus and a positive Thompson test. Imaging (ultrasound or MRI) confirms a full-thickness rupture of the Achilles tendon with retraction. The orthopedic foot and ankle surgeon schedules operative repair with augmentation using a graft to restore tendon continuity, improve repair strength, and optimize functional recovery.
The clinical workflow includes preoperative evaluation and consent, anesthesia planning (regional block or general), intraoperative exploration and debridement of tendon ends, placement of an autograft or allograft to augment the repair, layered wound closure, postoperative immobilization in plantarflexion, and structured rehabilitation with progressive range-of-motion and strengthening. Typical perioperative documentation includes operative report describing graft type and placement, estimated blood loss, anesthesia, laterality, and any intraoperative complications. The procedure aims to restore function and relieve pain caused by the rupture.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting only the physician’s professional component separate from technical services (rare for OR procedures). |