Open primary repair of a cruciate ligament of the knee using direct suture or augmentation technique.

Verified May 8, 2026 · 6 sources ↓

Medicare: $748.18
Total RVUs: 22.4
Global, days: 90
Region: Knee

Drawn from CMSAAOS

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 6 cited references ↓

Specify which ligament was repaired — ACL or PCL — by name in the operative report
Document the technique used: direct suture, imbrication, or augmentation, and whether any local tissue was used
Confirm no free-graft tunnel reconstruction was performed, which would shift the code selection
Record the surgical approach and visualization method (open arthrotomy details, not just 'standard approach')
Document pre-op imaging (MRI) confirming cruciate ligament tear and justifying primary repair over reconstruction
Note any concurrent procedures performed and whether they were addressed under separate CPT codes

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 51 Multiple procedures 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

27407 covers open primary repair of a cruciate ligament — anterior (ACL) or posterior (PCL) — performed through direct suture, imbrication, or augmentation without a full reconstruction using a free graft tunnel technique. This is distinct from 27407's neighbors in the knee ligament family: 27405 covers collateral ligament repair, while 27409 bundles cruciate and collateral repair together. If you're performing a full ACL reconstruction with graft harvest and tunnel drilling, that's a different code family entirely.

The 90-day global period applies. Every routine post-op visit, wound check, and cast change through day 90 is bundled. Bill unrelated E/M services with modifier 24; bill a significant, separately identifiable E/M on the day of surgery with modifier 25. Staged or unrelated procedures in the global window need modifier 79; unplanned returns for a complication of the original repair use modifier 78.

Site of service matters here. The spread between HOPD and ASC facility payments is substantial — see the Site of Service comparison table on this page. Most commercial payers follow CMS logic on this distinction, but verify your contract language, as some apply blended rates for knee ligament procedures at designated surgical facilities.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.58
Practice expense RVU	9.57
Malpractice RVU	2.25
Total RVU	22.4
Medicare national rate	$748.18
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	$748.18
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,256.83

Common denial reasons

The recurring reasons claims for CPT 27407 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Operative note describes tunnel drilling and graft passage, triggering a coding mismatch — payer downcodes or denies 27407
Missing or vague ligament identification in the operative note; auditors flag notes that say 'knee ligament repair' without naming ACL or PCL
Unbundling denial when 27407 and 27405 are billed together without documentation clearly supporting two distinct ligament repairs requiring separate work
Global period violation — post-op E/M billed without modifier 24 when the visit is routine and within the 90-day window
Medical necessity denial when pre-op imaging or clinical documentation doesn't support primary repair as appropriate versus reconstruction

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What's the difference between 27407 and ACL reconstruction codes?

27407 is for primary repair — reattaching or reinforcing the native ligament directly. ACL reconstruction involves harvesting or procuring a graft, drilling bone tunnels, and securing the graft in place. If tunnels are drilled, you're in reconstruction territory and 27407 is the wrong code.

02Can I bill 27407 and 27405 together if I repair both cruciate and collateral ligaments?

27409 is the correct single code when both cruciate and collateral ligaments are repaired in the same session. Billing 27407 and 27405 together instead of 27409 is a known bundling issue and will trigger NCCI edits.

03Does 27407 carry a global period, and what does that include?

Yes — 90-day global. That covers the surgery, the day-before visit, and all routine post-op care through day 90. Unrelated E/M visits need modifier 24. A new, unrelated surgical procedure in the global window needs modifier 79.

04If the patient needs a second procedure during the 90-day global because of a complication, what modifier applies?

Use modifier 78 for an unplanned return to the OR for a complication directly related to the original cruciate repair. Use modifier 79 only if the second procedure is completely unrelated to the original surgery.

05Does laterality need to be reported with 27407?

Yes. Append LT or RT to identify which knee. Payers — including Medicare Advantage plans — routinely reject knee procedure claims that omit laterality, and it's a straightforward fix before submission.

06When would modifier 22 be appropriate with 27407?

If the repair required substantially increased complexity — for example, due to severe joint instability, prior failed repair, or unusually difficult anatomy — modifier 22 is appropriate. Document the specific factors adding time and complexity; without that documentation, payers will reject the modifier 22 upcharge.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the ligament name (ACL vs. PCL), the repair technique (direct suture, imbrication, or augmentation), confirmation that no free graft or tunnel drilling was performed, and the surgical approach details from dictation. This prevents the single most common audit flag for 27407 — operative notes that can't distinguish primary repair from reconstruction, which triggers payer downcoding or requests for medical records.

See how Mira captures CPT 27407 documentation