Billing code 27640: Tibial bone excisionMedicare rate & RVUs in Missouri
Reports removal of a limited portion of tibial bone, commonly to clear localized diseased or infected bone such as in chronic osteomyelitis.
CMS doesn’t publish an office rate for 27640 in Missouri.
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 9 sections
What 27640 covers
The surgeon removes a limited area of tibial bone, using techniques such as saucerization, craterization, or removal of a bone sequestrum. Orthopedic surgeons typically perform this operation for localized disease, including chronic osteomyelitis, in a hospital or ambulatory surgical setting. The operative report should identify the tibia, the portion removed, and the condition treated.
Report this code for partial bone removal, not a more extensive tibial tumor resection or a procedure directed at a benign bone cyst or tumor. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. For bilateral procedures, modifier 50 is paid at 150%. Assistant-at-surgery payment is barred by statutory restriction; 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 27640 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City | Unavailable | $748.75 |
| Metropolitan St. Louis | Unavailable | $754.43 |
| Rest Of Missouri | Unavailable | $725.64 |
How the 27640 rate is calculated
Each of 27640’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 · 27640
RVUs × geographic indexes × conversion factor
Work11.93
11.93 RVUs× 1.000 GPCI
Practice expense8.90
8.90 RVUs× 1.000 GPCI
Malpractice2.18
2.18 RVUs× 1.000 GPCI
Adjusted RVUs
23.0100
Conversion factor
$33.4009
Medicare rate
$768.55
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 27640
27640 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 27640
Tibial bone excision
| 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) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| 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 · 27640
Tibial bone excision
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
27640 without 50 · national facility
$768.55
Tibial bone excision
27640-50 · Bilateral: 150%
$1,152.83
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).
27640 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 27635Bone lesion removal
- Code 27635 is for excision or curettage of a bone cyst or benign tumor in the tibia or fibula. Code 27640 describes partial tibial bone excision, including techniques used to remove diseased bone.
- 27637Bone lesion grafting
- Code 27637 includes allograft in treatment of a tibial or fibular bone cyst or benign tumor. Code 27640 describes partial tibial bone removal without that graft-specific service.
- 27641Fibula excision
- Code 27641 applies to partial excision of the fibula; code 27640 applies to the tibia.
- 27645Tibial tumor resection
- Code 27645 is for tibial tumor resection. Code 27640 is for partial excision rather than tumor resection.
27640 billing questions
How does this differ from code 27635?
Use 27640 for partial tibial bone removal such as saucerization or sequestrectomy. Code 27635 describes excision or curettage for a bone cyst or benign tumor.
When is code 27645 more appropriate?
Code 27645 describes resection of a tibial tumor. Use 27640 when the documented service is a partial excision rather than tumor resection.
Can this code be reported for both tibias?
For a bilateral procedure, report modifier 50; CMS pays the bilateral service at 150%.
Is related postoperative care included?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be paid?
Assistant-at-surgery payment is barred by 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
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