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Billing code 27691: Tendon transferMedicare rate & RVUs

Reports operative rerouting of one deep lower-leg tendon to a new attachment, such as a posterior tibial transfer to address foot drop.

CMS RVU26DEffective Oct 1, 2026109 payment localities6.6K Medicare services in 2024

Medicare pays $702.42 for 27691 nationally in a facility.

Medicare rate · 27691

Tendon transfer

Swap in your local Medicare rate.

Work RVUs
10.23
Total RVUs
21.03
Global days
090

National rate · 2026

$702.42

Facility setting, before claim adjustments.

See every locality for 27691 → · 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.

On this page 10 sections
  1. Medicare rate
  2. What 27691 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 27691 covers

An orthopedic surgeon mobilizes a deep tendon and redirects it to a different attachment to change the pull on the foot or ankle. A posterior tibial tendon transfer to help address foot drop is a typical example; deep tendon transfer may also be part of reconstructive surgery for tendon imbalance. These procedures are generally performed in an operating room, commonly in a hospital or ambulatory surgery setting.

Report this code for one deep lower-leg tendon transferred or rerouted, rather than a tendon that is simply repaired or lengthened. The operative report should identify the tendon, its original and new attachment, and the reason for the transfer. An additional tendon may be reported with the applicable add-on code. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in one session, the highest-valued is paid in full and others at 50%; bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be made; co-surgeon payment requires 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 27691 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

27691 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$639.16
Alaska*Unavailable$866.50
ArizonaUnavailable$684.60
ArkansasUnavailable$631.34
AtlantaUnavailable$720.09
AustinUnavailable$713.92
BakersfieldUnavailable$714.91
Baltimore/Surr. CntysUnavailable$743.86
BeaumontUnavailable$671.07
BrazoriaUnavailable$689.50

27691 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.

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View every state and territory as a table
27691 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 27691 rate is calculated

Each of 27691’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 · 27691

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 10.23Practice expense 9.04Malpractice 1.76

21.0300 adjusted RVUs×$33.4009 conversion factor=$702.42

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 27691

27691 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 27691

Tendon transfer

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)2Paid.
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 · 27691

Tendon transfer

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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

27691 without 50 · national facility

$702.42

Tendon transfer

27691-50 · Bilateral: 150%

$1,053.63

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

27691 compared with similar codes

Compare codes

27691 vs 27690 vs 27692 vs 27685 vs 27658: national Medicare rates

Swap in your local Medicare rate.

  • 27691
    Tendon transfer · 10.23 wRVU
    —
  • 27690
    Tendon transfer · 8.94 wRVU
    —
  • 27692
    Tendon transfer · 1.82 wRVU
    —
  • 27685
    Tendon lengthening · 6.52 wRVU
    $681.71
  • 27658
    Tendon repair · 4.99 wRVU
    —

How to choose

27690Tendon transfer
Choose 27691 for a deep tendon transfer and 27690 for a superficial tendon transfer. The operative report should establish which tendon was rerouted.
27692Tendon transfer
27692 represents an additional tendon in a transfer procedure; it is not the primary code for the first tendon.
27685Tendon lengthening
27685 is used for tendon lengthening. Use 27691 when the tendon is redirected to a different attachment rather than lengthened.
27658Tendon repair
27658 addresses tendon repair. A transfer to a new attachment is the distinguishing service for 27691.

Codes related to 27691

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

Codes related to 27691
CodeHow it relatesNational office range
Same family
27690Tendon transferTransfer of a superficial lower-leg tendon rather than a deep tendon.No office rate
Add-on codes
27692Tendon transferAdd-on code for an additional tendon transferred with the primary procedure.No office rate
Used instead
27685Tendon lengtheningLengthens a lower-leg tendon when lengthening, rather than rerouting, is the intended procedure.$605.73–$882.89
27658Tendon repairRepairs a lower-leg tendon rather than transferring it to a new attachment.No office rate

27691 billing questions

How is this code distinguished from 27690?

This code is for transfer of a deep lower-leg tendon. Code 27690 describes transfer of a superficial tendon.

Can an additional tendon be reported?

Yes. Report 27692 for an additional tendon when the documentation supports the additional transfer and the code's add-on requirements are met.

Does a tendon repair qualify as a transfer?

No. This code describes rerouting a tendon to a new attachment; repair codes describe treatment of a tendon injury without that transfer.

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 surgery reported under the CMS facts?

For a bilateral procedure reported with modifier 50, CMS pays at 150%. Multiple procedures in the same session are subject to the standard multiple procedure reduction.

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 27691PPRRVU2026_Oct_nonQPP.csv, line 3,009 (RVU26D)

Open CMS sourceHow we calculate rates

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