$572.22
Choose 27656 for primary repair of a leg flexor tendon without a graft; choose 27658 for secondary repair without a graft.
On this page
CMS RVU26D · Effective 2026-10-01
27658 Tendon repair Medicare reimbursement rates in Guam
Reports secondary repair without a graft of an injured flexor tendon in the leg, with one code unit for each tendon repaired. Compare 27658 office and facility rates across CMS payment localities in Guam.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 27658 in Guam?
Guam has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$368.97
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Orthopedic surgery
About 27658: Secondary leg flexor tendon repair
Reports secondary repair without a graft of an injured flexor tendon in the leg, with one code unit for each tendon repaired.
This code describes secondary repair of a flexor tendon in the leg without a graft. It is used when the surgeon repairs a tendon after the primary repair period, such as for a delayed injury or a tendon requiring secondary reconstruction. An orthopedic or foot and ankle surgeon typically performs the operation in a hospital or ambulatory surgery center. The operative report should identify the tendon and explain the circumstances supporting secondary rather than primary repair.
Report one unit for each tendon repaired, and document that no graft was used. Medicare assigns a 90-day global period; the day-before preoperative visit and 90 days of related postoperative care are included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate for this descriptor or anatomy. Assistant-at-surgery payment may be made; co-surgeons require supporting documentation, and team-surgery payment is not permitted.
CMS billing rules for 27658
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU4.99 · 47%
- Practice expense (office) RVU4.94 · 46%
- Malpractice RVU0.76 · 7%
3K
Medicare services in 2024 · #2187 by national volume
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.
27658 compared with similar codes
Office rates for Guam, from the same CMS release.
No office rate
Both describe secondary leg flexor tendon repair, but 27659 is used when a free graft is used.
No office rate
27665 is for secondary repair of a leg extensor tendon. Identify whether the repaired tendon is a flexor or extensor before selecting the code.
No office rate
27654 describes secondary repair of a ruptured Achilles tendon; 27658 is for a leg flexor tendon other than the Achilles.
Compare 27658 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Hawaii, Guam →
Office / nonfacility
Unavailable
Facility
$368.97
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 27658 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
2,997
- Code
- 27658
- Physician work
- 4.99
- Practice expense
- 4.94
- Malpractice
- 0.76
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.99 | × 1.000 | 4.9900 |
| Practice expense | 4.94 | × 1.137 | 5.6168 |
| Malpractice | 0.76 | × 0.579 | 0.4400 |
| Total RVUs | 11.0468 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$368.97
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.99 | 1 |
| Practice expense | 4.94 | 1.137 |
| Malpractice | 0.76 | 0.579 |
(4.99 × 1 + 4.94 × 1.137 + 0.76 × 0.579) × $33.4009 = $368.97
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
27658 billing questions
How does this differ from 27656?
27658 is for secondary repair of a leg flexor tendon without a graft. 27656 is the primary-repair code for that tendon type.
When is 27659 more appropriate?
Use 27659 for secondary leg flexor tendon repair when a free graft is used. This code is for secondary repair without a graft.
Should modifier 50 be used for bilateral repairs?
No. CMS identifies bilateral adjustment as inappropriate for this descriptor or anatomy.
How many units should be reported when multiple tendons are repaired?
The code is reported for each tendon repaired. The operative documentation should identify each tendon treated.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
2,99427652,,Repair/graft achilles tendon,A,,10.51,6.56,NA,6.56,,1.39,18.46,18.46,0,090,0.10,0.69,0.21,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,99527654,,Repair of achilles tendon,A,,10.27,8.35,NA,8.35,,1.62,20.24,20.24,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,99627656,,Repair leg fascia defect,A,,4.59,10.72,,4.41,,0.61,15.92,9.61,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,99727658,,Repair of leg tendon each,A,,4.99,4.94,NA,4.94,,0.76,10.69,10.69,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,99827659,,Repair of leg tendon each,A,,6.92,5.46,NA,5.46,,0.99,13.37,13.37,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,99927664,,Repair of leg tendon each,A,,4.61,4.98,NA,4.98,,0.71,10.30,10.30,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,00027665,,Repair of leg tendon each,A,,5.43,5.66,NA,5.66,,0.87,11.96,11.96,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014