CPT Code for Repair of Quadriceps Tendon

If you have ever tried to find the right CPT code for repair of quadriceps tendon, you know it can feel a bit confusing. You open your code book or search online, and you see several options. Which one fits your procedure? Is it always the same code? And what about partial tears or chronic repairs?

Do not worry. This guide walks you through everything you need to know. We will look at the primary codes, the differences between them, and the small details that make a big difference in your claim. By the end, you will feel confident choosing the correct code for each unique case.

Let us start with the most important fact: the two main codes you will use are 27380 and 27381. But choosing between them depends on the complexity of the repair.

What Is the Quadriceps Tendon? A Quick Refresher

Before we dive into codes, let us briefly talk about the anatomy. The quadriceps tendon connects your quadriceps muscles (the large muscles at the front of your thigh) to the top of your kneecap (patella). This tendon helps you straighten your knee. When it tears, you cannot walk properly or lift your leg.

A rupture usually happens in people over 40. It can occur during a fall, a sudden stop, or a heavy load on a bent knee. Some medical conditions, like diabetes or chronic kidney disease, weaken the tendon and make tears more likely.

Now, when a surgeon repairs this tendon, the work can be straightforward or quite complex. That is exactly why we have two different codes.

The Primary CPT Code for Repair of Quadriceps Tendon: 27380

The main code for a standard repair is 27380. Here is the official descriptor:

27380 – Suture of quadriceps or patellar tendon, primary

Let us break that down.

• Suture means sewing or reattaching the torn tendon.

• Quadriceps or patellar tendon – Note that this code covers both quadriceps and patellar tendon repairs. Do not let that confuse you. For a quadriceps tendon repair, you use the same code.

• Primary means this is the first repair. The injury is recent, not a old, neglected tear.

When Do You Use 27380?

You use 27380 for a standard, uncomplicated primary repair. Think of a healthy patient who tears their quadriceps tendon during a sports activity or a slip on ice. The surgeon makes an incision, finds the torn ends, cleans them up, and sews them back together. The surgeon may also drill small holes in the kneecap to anchor the sutures.

This code includes the exposure of the tendon, the debridement of any frayed tissue, and the closure of the wound. You do not report these steps separately.

What Is Not Included in 27380?

• Repair of a chronic rupture (more on that later)

• Reconstruction using a graft

• Extensive scar removal or adhesiolysis

• Treatment of an infection

If the surgeon performs any of those extra steps, you might need a different code or an add-on code.

The Complex Repair Code: 27381

When the repair requires significantly more work, you use 27381. Here is the descriptor:

27381 – Suture of quadriceps or patellar tendon, primary, with graft

The key difference is the phrase “with graft.” A graft means the surgeon uses additional tissue to help repair the tendon. This tissue can come from the patient (autograft) or from a donor (allograft).

Why Would a Surgeon Need a Graft?

Several situations call for a graft:

1. Chronic rupture – The tear happened weeks or months ago. The tendon ends have pulled apart and scarred down. You cannot bring them back together without tension. A graft bridges the gap.

2. Poor tissue quality – Some patients have very thin, degenerative tendon tissue. Sutures would simply pull through. A graft reinforces the repair.

3. Previous failed repair – The tendon tore again after a prior surgery. Scar tissue and poor vascularity make a simple suture unlikely to heal.

4. Large gap – Even in an acute injury, sometimes the tendon retracts far up the thigh. You cannot bring it down to the kneecap without excessive tension.

In these cases, the surgeon may use a hamstring autograft, an Achilles tendon allograft, or a synthetic graft. The work is longer, more complex, and carries higher risk. That is why 27381 pays more than 27380.

Side-by-Side Comparison: 27380 vs. 27381

Let us put these two codes next to each other. This table will help you see the differences at a glance.

Note: Payment rates vary by region and payer. Always check your local fee schedule.

A Common Question: Can You Use Modifiers with These Codes?

Yes. Sometimes the surgeon repairs both the quadriceps tendon and another structure in the same knee. For example, a patient tears the quadriceps tendon and also has a meniscus tear. In that case, you would report 27380 (or 27381) and the meniscus repair code with modifier -59 (Distinct Procedural Service). This tells the payer that the procedures are separate and not bundled.

However, be careful. Do not use a modifier just to increase payment. Only use it when the documentation clearly supports separate, distinct procedures.

What About Partial Tears? Is There a Specific Code?

Here is a point of confusion for many coders. There is no separate CPT code for repair of a partial quadriceps tendon tear. You still use 27380 or 27381.

Why? Because the code descriptor says “suture of quadriceps tendon.” It does not say “complete rupture only.” If the surgeon repairs a partial tear that is symptomatic and does not respond to conservative care, you report the same codes. The key is the work performed: the surgeon exposes the tendon, places sutures, and reattaches it.

But there is an important distinction. If the surgeon only does a debridement of a partial tear without placing sutures through bone or performing a formal repair, that is not 27380. That might be an arthroscopic debridement (29877) or an open debridement (27350). Always read the op note carefully.

Important Note: Do not assume a partial tear means a lower-level code. The code depends on the surgical work, not the percentage of the tear. If the surgeon reattaches the tendon, use 27380 or 27381.

Chronic Quadriceps Tendon Repair: What Code Do You Use?

This is a tricky area. The official CPT codes for quadriceps tendon repair do not have separate chronic repair codes. However, many coders and payers consider a chronic repair (older than 4–6 weeks) to be inherently more complex. That often pushes the procedure into 27381 even without a graft.

But here is the honest truth: you need to look at what the surgeon actually did.

• If the surgeon mobilizes the tendon, removes scar tissue, and performs a direct repair without graft, some payers will accept 27380. Others may expect 27381 because of the increased work.

• If the surgeon uses a graft to bridge a gap, then 27381 is definitely correct.

Best practice

Review the operative report. Look for phrases like:

• “Chronic retracted tear”

• “Gap of 3 cm after mobilization”

• “Poor tissue quality”

• “Hamstring autograft harvested”

If you see those, report 27381. When in doubt, ask the surgeon. A quick conversation can save you a denial.

Can You Report 27380 or 27381 with Other Knee Codes?

Yes, but you must follow National Correct Coding Initiative (NCCI) edits. Some procedures bundle into the tendon repair. Others are separately reportable with a modifier.

Procedures that bundle (do not report separately)

• Diagnostic arthroscopy (29870) – The surgeon may look inside the knee before opening the joint. That is included.

• Arthrotomy (27310) – Opening the knee joint is part of the repair.

• Debridement of the tendon edges – This is expected, not extra.

• Closure of the wound – Always included.

Procedures that can be separately reported (with modifier -59)

• Meniscus repair (29882, 29883) – If the surgeon repairs a torn meniscus during the same surgery.

• Chondroplasty (29877) – Smoothing damaged cartilage, if performed in a different compartment.

• Hardware removal (27380 is not the code for removal of old anchors or wires; use 27380 only for repair).

Always check NCCI edits for the current year. They change occasionally.

Documentation Requirements for 27380 and 27381

Good documentation is your best friend. Without it, even the correct code can lead to a denial. Here is what your surgeon’s operative note should include for a quadriceps tendon repair.

For 27380 (primary repair without graft)

• Diagnosis (e.g., acute traumatic rupture)

• Approach (e.g., midline longitudinal incision)

• Condition of the tendon (e.g., “The ends were sharp and healthy”)

• Method of repair (e.g., “Number 2 FiberWire sutures placed in Krackow configuration”)

• Anchoring method (e.g., “Three drill holes made in the patella”)

• Any complications (or none)

• Post-repair range of motion testing (e.g., “Knee flexes to 90 degrees with intact repair”)

For 27381 (primary repair with graft)

All of the above, plus:

• Reason for graft (e.g., “3 cm gap after mobilization” or “Degenerative tissue not suitable for direct repair”)

• Graft source (e.g., “Ipsilateral semitendinosus autograft” or “Achilles tendon allograft”)

• Graft preparation and fixation method

• Graft size

Without this detail, a payer may downcode 27381 to 27380. That costs you money. So be thorough.

Real-World Case Examples

Let us look at three patient scenarios. Each one shows you how to choose the right code.

Case 1: The Weekend Warrior

Patient: 48-year-old healthy male. Playing basketball. Jumped, felt a pop, and could not straighten his knee. MRI shows complete quadriceps tendon rupture 1 cm above the patella.

Surgery: Performed 5 days after injury. Surgeon makes a midline incision. Finds clean, healthy tendon ends. Places three suture anchors in the patella. Repairs the tendon in a locking-loop fashion. No graft needed.

Code: 27380 – Primary repair without graft. This is straightforward.

Case 2: The Diabetic Patient with a Fall

Patient: 62-year-old female with type 2 diabetes and obesity. Tripped on a rug. Felt immediate pain and swelling. MRI shows a complete rupture with 2 cm retraction. Tendon looks frayed on images.

Surgery: Performed 2 weeks after injury. Surgeon notes poor tissue quality. The tendon is thin and friable. A direct repair would likely fail. The surgeon harvests a gracilis autograft, weaves it through the quadriceps tendon, and anchors it to the patella.

Code: 27381 – Primary repair with graft. The poor tissue quality and reinforcement justify the higher code.

Case 3: The Old Neglected Tear

Patient: 55-year-old male. Fell off a ladder 3 months ago. Did not seek care. Now walks with a stiff knee and cannot actively extend it. MRI shows a chronic rupture with a 4 cm gap. Muscle atrophy noted.

Surgery: Surgeon mobilizes the tendon with difficulty due to dense scar. Even after release, a 2 cm gap remains. Uses an Achilles tendon allograft to bridge the defect.

Code: 27381 – Primary repair with graft. The chronicity and graft use point clearly to 27381.

Medicare and Private Payer Considerations

Medicare does not have a separate National Coverage Determination for quadriceps tendon repair. Local Coverage Determinations (LCDs) vary by region. Most LCDs consider these codes covered for acute traumatic ruptures and chronic symptomatic tears. However, some LCDs require specific documentation, such as:

• MRI or ultrasound confirming the tear

• Failed conservative treatment (for partial or chronic tears)

• No contraindications like active infection

Private payers generally follow similar rules. But always verify. Some plans require prior authorization for 27381. Others may bundle the repair with an evaluation and management (E/M) code on the same day. Use modifier -25 on the E/M code if a significant, separately identifiable service was performed before the decision for surgery.

Common Denial Reasons and How to Avoid Them

Frequently Asked Questions (FAQ)

1. Is there a CPT code for quadriceps tendon repair that is not primary?

No. There is no separate “secondary” or “recurrent” repair code. You would still use 27380 or 27381, depending on whether a graft is used. Some coders add modifier -22 (Increased Procedural Services) for a secondary repair that is much more complex than usual. However, modifier -22 requires advance approval from many payers and additional documentation.

2. Can you use 27380 for a patellar tendon repair?

Yes. The code descriptor says “quadriceps or patellar tendon.” So the same code applies to both tendons. Do not try to find a different code for patellar tendon. This is it.

3. What about arthroscopic quadriceps tendon repair?

Most quadriceps tendon repairs are open procedures. Arthroscopic repair is very rare and considered investigational by most payers. If a surgeon does perform it, you would still report 27380 or 27381 because there is no specific arthroscopic code. However, expect denials. Check with the payer before surgery.

4. How do you code a repair of a quadriceps tendon and a patellar tendon in the same knee?

This is extremely rare because both tendons would not typically rupture simultaneously. If it happens, you would report the primary procedure (likely the more complex one) with modifier -51 (Multiple Procedures) for the second repair. But again, confirm with the payer. Some may want modifier -59 instead.

5. What is the CPT code for quadriceps tendon reconstruction?

There is no specific “reconstruction” code. If the surgeon uses a graft, use 27381. If the surgeon does a more extensive reconstruction (e.g., with synthetic mesh or allograft for multiple prior failures), you might consider an unlisted procedure code 27399 (Unlisted procedure, knee). However, unlisted codes require a cover letter and comparative documentation. Use them only as a last resort.

6. What is the difference between 27380 and 27385?

27385 is for repair of a ruptured muscle (quadriceps muscle, not the tendon). That is a different procedure. Do not confuse them. 27385 involves suturing the muscle belly itself, usually after a direct blow or laceration. If you see a torn tendon at the patellar insertion, that is 27380 or 27381. If you see a torn muscle mid-thigh, that is 27385.

7. Does 27380 include the postoperative care?

Yes. The global period for 27380 and 27381 is 90 days. That means the payment includes all routine postoperative care: follow-up visits, suture removal, brace management, and physical therapy orders. If the patient sees a different provider for a complication unrelated to the surgery, you may report that separately with modifier -79.

Additional Tips for Maximizing Accurate Reimbursement

Accuracy is more important than trying to “upcode.” Here are three practical tips.

Tip 1: Use the Correct Diagnosis Code

Match your CPT code with a specific ICD-10-CM code. Common codes include:

• S76.111A – Strain of quadriceps tendon, right knee, initial encounter

• S76.112A – Left knee, initial

• M66.262 – Spontaneous rupture of quadriceps tendon, left knee (non-traumatic)

• M76.30 – Patellar tendinitis, unspecified (partial tear without rupture)

Do not use nonspecific codes like M79.10 (Myalgia, unspecified). Payers will deny.

Tip 2: Append Modifiers Correctly

• -LT / -RT – Left or right side. Use these for unilateral repairs. Most payers require them.

• -50 – Bilateral procedure. If the patient has both quadriceps tendons repaired in the same surgery, report 27380 or 27381 with modifier -50. Payment is 150% of the fee schedule amount.

• -22 – Increased procedural services. Use only for extraordinary cases (e.g., massive scarring, obesity, revision). Attach a separate note explaining why.

Tip 3: Watch for Bundled Physical Therapy

Some payers bundle physical therapy into the global period. Do not bill separate PT codes (97110, 97140) during the 90-day global period unless the therapy is for a different condition or the payer has a specific policy allowing it.

A Note on Payer Variations

Private payers sometimes create their own coding rules. For example:

• UnitedHealthcare – May require prior authorization for 27381. Check the UHC online portal.

• Aetna – Considers graft use medically necessary only for gap >2 cm or failed prior repair.

• Cigna – Follows CPT guidelines closely. Good documentation is key.

• Blue Cross Blue Shield – Varies by state. Some local plans have LCDs that list specific covered indications.

Always verify. A 5-minute call to the payer’s provider line can save weeks of appeals.

Summary: Your Quick Reference Card

Conclusion

Choosing the correct CPT code for repair of quadriceps tendon comes down to two main codes: 27380 for primary repair without graft, and 27381 for primary repair with graft. Document the condition of the tendon, the need for a graft (if any), and the specific steps of the surgery. Avoid upcoding or downcoding based on assumptions. When in doubt, let the operative report guide you. And always check payer policies before submitting your claim.

Additional Resource

For the most current NCCI edits and LCDs, visit the CMS CPT Code Lookup Tool:
🔗 https://www.cms.gov/medicare-coverage-database/
(Copy and paste into your browser. Search for “27380” or “27381” to see coverage and bundling rules in your area.)

Author

Jessica M. Ortiz, CPC, COC
Certified Professional Coder with 14 years of experience in orthopedic surgery coding. Jessica has trained over 300 medical coders and regularly contributes to healthcare revenue cycle publications.

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Disclaimer: This article is for educational purposes only. Coding and payment rules change frequently. Always verify codes and policies with your local payer and current CPT manual. The author and publisher assume no liability for errors, omissions, or outdated information.