Summary & Overview
CPT 27880: Transtibial (Below-Knee) Amputation, Closure
CPT code 27880 denotes a transtibial (below-knee) amputation — a surgical removal of the leg through the lower leg bones with closure of skin flaps, typically performed to relieve pain or remove nonhealing tissue in the setting of poor vascular supply. This code captures a major limb amputation procedure with significant clinical, functional, and cost implications nationally, given its association with chronic vascular disease, infection, and limb-threatening ischemia.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical description, expected sites of service, and the common payer landscape for this procedure. The analysis highlights benchmarking considerations, common modifier usage, and the clinical context that drives utilization, including indications related to nonhealing tissue and poor perfusion. Policy-relevant topics covered include coverage criteria, authorization patterns, and coding specificity for surgical amputation services.
This publication is intended to inform coding professionals, revenue cycle managers, and clinical leadership about the definition and billing context of CPT code 27880, and to outline where to focus further review for reimbursement, quality measurement, and clinical documentation improvements. Data not available in the input is explicitly noted where applicable.
Billing Code Overview
CPT code 27880 describes a transtibial (below-knee) amputation, in which the provider amputates the leg below the knee through the bones of the lower leg and closes the remaining skin flaps around the amputation site. The procedure is performed to relieve pain or remove nonhealing tissue when there is poor vascular supply.
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Service type: Surgical amputation procedure
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Typical site of service: Inpatient or outpatient hospital operating room, or ambulatory surgical center depending on patient condition and acuity
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with a long history of peripheral arterial disease and poorly controlled type 2 diabetes presents with a nonhealing ischemic ulcer and gangrene of the lower leg below the knee. Prior revascularization attempts were unsuccessful and the limb is painful with recurrent infection. The vascular surgery team evaluates the patient in the hospital setting, documents failed limb salvage, discusses risks and benefits of below-knee amputation, and obtains informed consent. The patient is optimized preoperatively (antibiotics, glycemic control, DVT prophylaxis) and taken to the operating room under general or regional anesthesia. The surgeon performs a transtibial amputation by transecting the tibia and fibula, creating and closing well-vascularized skin flaps, achieving hemostasis, and applying a dressing and drain if indicated. Postoperative care includes pain control, wound monitoring, physical therapy planning for prosthetic fitting, and coordination with case management for discharge and durable medical equipment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
50 | Bilateral Procedure | When both lower extremities undergo transtibial amputations during the same operative session. |
LT |