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CPT code 27681: Tenolysis, multiple tendons2026 Medicare rate & RVUs

Surgical release of adhesions involving multiple lower-leg or ankle tendons, reported when tethering limits tendon glide and motion.

CMS RVU26DEffective Oct 1, 2026109 payment localities150 Medicare services in 2024

Medicare pays $489.66 for 27681 nationally in a facility.

Medicare rate · 27681

Tenolysis, multiple tendons

Office or facility?

Work RVUs
6.87
Total RVUs
14.66
Global days
090

National rate · 2026

$489.66

Facility setting, before claim adjustments.

See every locality for 27681 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 27681 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 27681 covers

Tenolysis frees flexor or extensor tendons in the lower leg or ankle from adhesions that restrict their movement. A typical situation is persistent tendon tethering after a prior tendon repair, fracture, or ankle operation, with impaired excursion despite appropriate recovery or therapy. An orthopedic surgeon, often a foot-and-ankle specialist, performs the release in an operating room.

Report this code when the operation releases multiple tendons; use the single-tendon sibling when only one tendon is released. The operative report should identify the tendons, side, adhesions, and work performed to restore tendon glide. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; co-surgeons require supporting documentation, and team surgery is 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 27681 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

27681 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$444.34
AlaskaUnavailable$600.01
ArizonaUnavailable$476.91
ArkansasUnavailable$438.72
Atlanta, GAUnavailable$502.17
Austin, TXUnavailable$498.08
Bakersfield, CAUnavailable$498.83
Baltimore area, MDUnavailable$519.12
Beaumont, TXUnavailable$467.03
Brazoria, TXUnavailable$480.41

27681 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
27681 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 27681 rate is calculated

Each of 27681’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 · 27681

RVUs × geographic indexes × conversion factor

Office or facility?

Work6.87

6.87 RVUs× 1.000 GPCI

Practice expense6.55

6.55 RVUs× 1.000 GPCI

Malpractice1.24

1.24 RVUs× 1.000 GPCI

Adjusted RVUs

14.6600

Conversion factor

$33.4009

Medicare rate

$489.66

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 27681

27681 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 27681

Tenolysis, multiple tendons

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.69/0.21Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 27681

Tenolysis, multiple tendons

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

27681 without 50 · national facility

$489.66

Tenolysis, multiple tendons

27681-50 · Bilateral: 150%

$734.49

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).

When to use modifier 50

27681 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 27681

    Tenolysis, multiple tendons6.87 wRVU

    Not priced

  • 27680

    Tendon release, single leg or ankle tendon5.73 wRVU

    Not priced

  • 27685

    Tendon lengthening, single tendon, leg or ankle6.52 wRVU

    $681.71

  • 27686

    Tendon adjustment, multiple tendons, same incision7.56 wRVU

    Not priced

  • 27690

    Tendon transfer, single lower-leg tendon8.94 wRVU

    Not priced

How to choose

27680Tendon releaseSingle leg or ankle tendon
27680 is for release of one tendon. Choose 27681 when multiple lower-leg or ankle tendons are released from adhesions.
27685Tendon lengtheningSingle tendon, leg or ankle
27685 describes lengthening or shortening a single tendon to address tendon tightness or length. Tenolysis instead frees adhesions restricting tendon glide.
27686Tendon adjustmentMultiple tendons, same incision
27686 addresses lengthening or shortening multiple tendons. Report 27681 when the operative work is releasing adhesions from multiple tendons.
27690Tendon transferSingle lower-leg tendon
27690 involves tendon transfer or rerouting. It is distinct from freeing multiple tendons from adhesions without transferring them.

Codes related to 27681

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 27681
CodeHow it relatesNational office range
Same family
27680Tendon release, single leg or ankle tendonSibling code for release involving one lower-leg or ankle tendon.No office rate
Used instead
27685Tendon lengthening, single tendon, leg or ankleFor lengthening or shortening a single leg or ankle tendon rather than releasing adhesions.$605.73–$882.89
27686Tendon adjustment, multiple tendons, same incisionFor lengthening or shortening multiple leg or ankle tendons rather than releasing adhesions.No office rate
27690Tendon transfer, single lower-leg tendonFor transferring a tendon when tendon rerouting, not adhesion release, is performed.No office rate

27681 billing questions

When should I report 27681 rather than 27680?

Use 27681 when the surgeon releases multiple lower-leg or ankle tendons from adhesions. Use 27680 when the release involves one tendon.

Should I report a separate unit for each tendon released?

This code describes release involving multiple tendons, so do not repeat the single-tendon code solely to count each tendon. Document the tendons treated and the release performed.

What documentation supports the multiple-tendon code?

The operative report should identify the affected tendons and side, describe adhesions that restricted glide, and explain the release performed on the multiple tendons.

How does the 90-day global period affect postoperative billing?

The day-before preoperative visit and 90 days of related postoperative care are included in the global period.

How is bilateral tenolysis handled?

For a bilateral procedure, modifier 50 is paid at 150%. The standard multiple-procedure reduction also applies when procedures are performed in the same session.

Can an assistant or co-surgeon be billed for this operation?

Assistant-at-surgery payment is subject to a statutory restriction. Co-surgeons are paid only with supporting documentation; team surgery is 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
RVUs for 27681PPRRVU2026_Oct_nonQPP.csv, line 3,004 (RVU26D)

Open CMS sourceHow we calculate rates

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