Open arthrotomy of the knee with surgical repair of the meniscus performed through a direct incision into the joint.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $610.57
- Total RVUs
- 18.28
- Global, days
- 90
- Region
- Knee
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 6 cited references ↓
- Operative note must specify open arthrotomy approach — not just 'standard approach' — with incision location and joint entry described.
- Identify the meniscus repaired: medial, lateral, or both, and the specific tear pattern (e.g., root tear, bucket-handle, radial).
- Document the laterality of the knee (left or right) to support LT/RT modifier and prevent laterality-based denials.
- Describe the repair technique: suture type, anchor use, number of passes, and tissue quality encountered.
- Pre-operative imaging (MRI or diagnostic arthroscopy findings) corroborating the meniscal tear and necessity for open repair.
- Indications for open rather than arthroscopic approach, particularly if prior arthroscopic attempt or complex anatomy drove the decision.
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 6 cited references ↓
CPT 27403 covers open meniscus repair performed via arthrotomy — a direct surgical incision into the knee joint. It is the open-surgery counterpart to arthroscopic meniscus repair (29882/29883). Use 27403 when the repair is performed through an open approach; do not report both 27403 and an arthroscopic meniscus repair code for the same meniscus repair at the same session.
Meniscal root repairs fall under this code when performed open. Per AMA CPT Assistant guidance (May 2019), the meniscal root is anatomically part of the meniscus — report 27403 for open repair of the root, not a separate root repair code stacked on top of a meniscus repair code. If the root repair is arthroscopic, report 29882 instead.
The 90-day global period covers all routine postoperative care through day 90. Bill same-day E/M only with modifier 25 if a separately identifiable decision for surgery visit is documented. Return to the OR for a related complication within the global window requires modifier 78. An unrelated procedure in the global period requires modifier 79. LT and RT are required by most payers to lateralize the knee.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 8.4 |
| Practice expense RVU | 8.12 |
| Malpractice RVU | 1.76 |
| Total RVU | 18.28 |
| Medicare national rate | $610.57 |
| Global period | 90 days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $610.57 |
HOPD (APC 5114) Hospital outpatient department | $7,413.38 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $5,480.92 |
Common denial reasons
The recurring reasons claims for CPT 27403 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Unbundling with 29882/29883: payers deny 27403 when an arthroscopic meniscus repair code is billed same-day for the same repair.
- Missing or ambiguous laterality — claims without LT or RT modifiers are routinely rejected by commercial payers and Medicare Advantage plans.
- Lack of medical necessity documentation when pre-op MRI or clinical notes do not clearly support an open approach over arthroscopic repair.
- Global period overlap: post-op E/M visits billed without modifier 24 are automatically denied if they fall within the 90-day global window.
- Meniscal root coded as a separate additional procedure when the root repair is the same repair event as the meniscus repair under this code.
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01Can I bill 27403 and 29882 together for a meniscus repair performed in the same operative session?
02Is meniscal root repair billed separately from 27403?
03Which modifier do I use if the surgeon returns to the OR during the 90-day global for a complication related to the meniscus repair?
04Does 27403 require laterality modifiers?
05How does the 90-day global period affect same-day E/M billing?
06What is the difference in reimbursement between HOPD and ASC settings for 27403?
07When is modifier 22 appropriate for 27403?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02findacode.comhttps://www.findacode.com/newsletters/ama-cpt-assistant/surgery-musculoskeletal-system-may-2019-5.html
- 03cms.govhttps://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-faq-library
- 04cms.govhttps://www.cms.gov/files/document/2025nccimedicarepolicymanualcompletepdf.pdf
- 05aapc.comhttps://www.aapc.com/codes/cpt-codes/27403
- 06payerprice.comhttps://payerprice.com/rates/27403-CPT-fee-schedule
Mira AI Scribe
Mira's AI scribe captures the surgical approach (open arthrotomy), meniscus location (medial/lateral), tear pattern, repair technique, suture or anchor specifics, and laterality directly from dictation. That structured output pre-fills the operative note fields most likely to trigger a medical necessity or unbundling denial — and flags if the note is missing the rationale for open versus arthroscopic approach before the claim is submitted.
See how Mira captures CPT 27403 documentation