CPT code 27604: Bursa drainage, lower leg or ankle2026 Medicare rate & RVUs in Texas
Reports operative incision and drainage of a bursa in the lower leg or ankle, such as when a bursal collection requires open treatment.
Medicare pays $448.63–$492.25 for 27604 in the office in Texas, from Beaumont, TX to Austin, TX. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 27604 covers
An orthopedic or foot and ankle surgeon uses an incision to drain a bursa in the lower leg or ankle. The service is appropriate when the operative target is the bursa itself, rather than a separate soft-tissue lesion or the ankle joint. Documentation should identify the bursa and site, the reason open drainage was performed, and the operative work and findings.
Report this service for the bursal drainage, not for needle aspiration alone. The CMS global period is 90 days, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 27604 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$448.63 to $492.25
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | $492.25 | $321.92 |
| Beaumont, TX | $448.63 | $302.13 |
| Brazoria, TX | $470.10 | $310.56 |
| Dallas, TX | $473.89 | $313.54 |
| Fort Worth, TX | $471.24 | $312.50 |
| Galveston, TX | $472.01 | $312.15 |
| Houston, TX | $487.02 | $327.16 |
| Rest of Texas | $459.65 | $306.86 |
How the 27604 rate is calculated
Each of 27604’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 27604
RVUs × geographic indexes × conversion factor
Work4.48
4.48 RVUs× 1.000 GPCI
Practice expense9.00
9.00 RVUs× 1.000 GPCI
Malpractice0.82
0.82 RVUs× 1.000 GPCI
Adjusted RVUs
14.3000
Conversion factor
$33.4009
Medicare rate
$477.63
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 27604
27604 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 27604
Bursa drainage, lower leg or ankle
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 27604
Bursa drainage, lower leg or ankle
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
27604 without 50 · national office
$477.63
Bursa drainage, lower leg or ankle
27604-50 · Bilateral: 150%
$716.45
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
27604 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 27603Deep drainageLeg or ankle abscess/hematoma
- 27604 is for operative drainage of a lower-leg or ankle bursa. 27603 is for drainage of a lower-leg lesion, not specifically a bursa.
- 20605Joint procedureIntermediate joint, no ultrasound
- 20605 describes needle aspiration or injection of an intermediate joint or bursa. Use 27604 for open incision and drainage of a lower-leg or ankle bursa.
- 20610Joint injectionMajor joint or bursa, no ultrasound
- 20610 describes needle aspiration or injection of a major joint or bursa, not operative incision and drainage. The open bursal procedure is 27604.
- 27610Ankle arthrotomyExploration, drainage, or foreign body
- 27610 involves exploration or treatment of the ankle joint. 27604 targets a bursa in the lower leg or ankle, not the joint space.
27604 billing questions
How is this different from 27603?
Choose 27604 when the operative target is a bursa in the lower leg or ankle. Code 27603 describes drainage of a lower-leg lesion rather than a bursa.
Can needle aspiration of a bursa be reported as 27604?
No. 27604 describes operative incision and drainage; needle aspiration is a different service. Codes 20605 or 20610 may be relevant for aspiration or injection, depending on the bursa and site.
What should the operative note support?
Document the bursa and anatomic site, the indication for open drainage, and the incision, drainage, and operative findings. The record should make clear that the bursa, rather than an adjacent lesion or joint, was treated.
How does modifier 50 affect payment?
CMS identifies this as a bilateral procedure; reporting modifier 50 results in payment at 150%.
What are the assistant and global-surgery rules?
Assistant-at-surgery payment is allowed only when medical necessity is documented. The 90-day global period includes the day-before preoperative visit and related postoperative care; co-surgeons and team surgery are not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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