Surgical implantation of the patient's own cultured chondrocytes into a cartilage defect of the knee joint.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,494.69
Total RVUs: 44.75
Global, days: 90
Region: Knee

Drawn from CMSBeckersascUniverahealthcareAAPCNIH

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Confirmed full-thickness cartilage defect location — specify condyle (medial, lateral, or trochlear) in the operative note
Documentation of prior failed arthroscopic or surgical cartilage repair, establishing medical necessity per payer LCD criteria
Operative note for the separate chondrocyte harvest procedure (Stage 1) with date of service and corresponding CPT/HCPCS code
Name and lot number of the implanted biologic product (e.g., Carticel/MACI) to support J7330 billing
Patient age, defect size in cm², and symptom duration — most LCDs require these fields explicitly
Laterality documented (left vs. right knee) to support LT/RT modifier assignment

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

27412 covers the implantation stage of autologous chondrocyte implantation (ACI) — the open procedure where previously harvested and lab-cultured chondrocytes are placed into a prepared cartilage defect, typically on the femoral condyle. This is a two-stage process: the arthroscopic harvest (reported separately with 29870 or S2112) happens weeks before the implantation. 27412 covers only the implantation surgery itself. The biologic product — cultured chondrocytes — is billed separately under HCPCS J7330.

The 90-day global period means all routine post-op care through day 90 is bundled into 27412. Unrelated procedures within that window require modifier 79; a return to the OR for a complication related to the ACI requires modifier 78. Payer coverage policies for ACI are narrow: most carriers — including Medicare via Univera and similar LCD frameworks — restrict coverage to symptomatic full-thickness femoral condyle defects in patients who have failed prior surgical cartilage repair. ACI on joints other than the knee (e.g., talus) is typically classified as experimental/investigational and will be denied.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	24.12
Practice expense RVU	15.5
Malpractice RVU	5.13
Total RVU	44.75
Medicare national rate	$1,494.69
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	$1,494.69
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI G2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 27412 get rejected.

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

Missing proof of prior failed cartilage repair — payers treat ACI as a second-line procedure and deny without documented conservative or surgical failure
Billing 27412 and the harvest procedure on the same date of service — Stage 1 and Stage 2 are distinct encounters and must not share a DOS
Failure to separately bill J7330 for the cultured chondrocyte product — the implant cost is not bundled into 27412 and must be coded independently
Non-covered indication: ACI on joints other than the knee (e.g., ankle/talus) is considered experimental by most payers and requires strong prior authorization documentation
Missing or inadequate prior authorization — ACI routinely requires pre-authorization; claims submitted without it are denied regardless of medical necessity

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Does 27412 include the chondrocyte harvest, or is that billed separately?

The harvest is a separate encounter — typically reported with 29870 or S2112 — performed weeks before implantation. 27412 covers only the implantation surgery (Stage 2). Billing both on the same date of service will trigger a denial.

02How do I bill for the biologic product itself?

Bill HCPCS J7330 (autologous cultured chondrocytes, implant) separately from 27412. The product cost is not bundled into the surgical code. Include the product name and lot number in your documentation to support the J7330 claim.

03What ICD-10 diagnoses support 27412 for most payers?

Full-thickness femoral condyle cartilage defects — typically coded in the M17 (osteoarthritis, knee) or M12.56x (traumatic arthropathy, knee) ranges — are the most consistently covered diagnoses. Osteochondritis dissecans codes (M93.2x) are also accepted. Check your MAC's LCD for the complete accepted code list before submitting.

04Is 27412 covered for ACI on the ankle or talus?

No — not by most payers. ACI on joints other than the knee is classified as experimental/investigational by the majority of commercial payers and is not covered under standard Medicare policy. Expect denial without a specific plan-level exception or clinical trial enrollment.

05What modifier applies if the surgeon returns to the OR during the 90-day global for a wound complication from the ACI?

Use modifier 78 — unplanned return to the OR for a procedure related to the original surgery during the postoperative period. Modifier 79 is for unrelated procedures. Don't invert them; payers audit this distinction.

06Does the 90-day global for 27412 start from Stage 1 (harvest) or Stage 2 (implantation)?

The global period runs from the implantation date — the date of service on the 27412 claim. Stage 1 is a separate procedure with its own global period. Post-op care related to the implantation is bundled from that date forward through day 90.

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 defect location (medial condyle, lateral condyle, or trochlear), defect size in cm², the approach used, confirmation that this is the implantation stage (Stage 2), and the biologic product name and lot number from dictation. That detail prevents the most common denial trigger: a vague operative note that doesn't establish a covered indication or distinguish the implantation encounter from the prior harvest.

See how Mira captures CPT 27412 documentation