Open surgical transplantation of donor cartilage and bone to repair a full-thickness osteochondral defect of the knee joint.

Verified May 8, 2026 · 8 sources ↓

Medicare: $1,258.55
Total RVUs: 37.68
Global, days: 90
Region: Knee

Drawn from CMSAAPCZimmerbiometProvidencehealthplanLifenethealth

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Outerbridge grade of the defect (grade III or IV required for most payer approvals)
Lesion size and location — femoral condyle, tibial plateau, or patella — documented in the operative note
Knee alignment status and any concurrent corrective osteotomy performed at the same session
Confirmation that surrounding cartilage is normal or near-normal, with no osteoarthritis or inflammatory arthritis in the joint
Prior conservative or surgical treatment attempts and their outcomes, supporting medical necessity
Operative note naming the open approach explicitly — audit flags notes that omit approach or describe only 'standard' technique
Allograft source and type documented (fresh, fresh-frozen) to support device-intensive HCPCS billing
Any additional procedures performed in separate compartments documented with compartment location to support separate billing

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 59 Distinct service LT Left side RT Right side 24 Unrelated E/M during global 25 Significant separate E/M 78 Unplanned return — related 79 Unrelated during global 58 Staged or related

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

CPT 27415 covers an open osteochondral allograft of the knee — the surgeon directly accesses the joint, prepares the defect site, and seats a donor-derived osteochondral plug (cartilage plus subchondral bone) to restore the articular surface. This is the allograft-specific code; if the surgeon harvests graft from the patient instead, use 27416 (open autograft). If the procedure is performed arthroscopically with allograft material, use 29867 instead.

The 90-day global period covers the surgery, the day-before visit, and all routine post-op care through day 90. Payers apply strict medical necessity criteria: most require a focal, full-thickness defect (Outerbridge grade III–IV), surrounded by normal or near-normal cartilage, in a knee with normal alignment or alignment corrected at the same session, and without inflammatory arthritis or osteoarthritis beyond the focal lesion. Document all of these criteria explicitly — prior conservative treatment failures, lesion size, Outerbridge grade, and alignment status.

Both 27415 and 29867 carry OPPS status indicator J1 (device-intensive, APC 5115). Facilities billing under HOPD or ASC should also submit a HCPCS device code (C1889 or L8699) to capture allograft acquisition costs. Arthroscopic procedures bundled under 27415 — including loose body removal, chondroplasty, abrasion arthroplasty, microfracture, and OCD drilling — are included when performed in the same compartment; bill those codes separately only if performed in a different compartment, and append modifier 59.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	19.5
Practice expense RVU	14.03
Malpractice RVU	4.15
Total RVU	37.68
Medicare national rate	$1,258.55
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	$1,258.55
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$10,492.07

Common denial reasons

The recurring reasons claims for CPT 27415 get rejected.

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

Medical necessity not established — missing Outerbridge grade, lesion size, or documentation of failed prior treatment
Wrong code selected — 29867 (arthroscopic allograft) billed when the operative note documents an open approach, or vice versa
Autograft vs. allograft mismatch — 27415 billed when surgeon harvested graft from the patient (use 27416 instead)
Bundled same-compartment procedures billed separately without modifier 59, triggering NCCI edit denials
Knee alignment not addressed — payers deny when the operative note shows malalignment and no concurrent osteotomy is documented or planned
Missing or incorrect HCPCS device code at facility — C1889 or L8699 omitted when billing under HOPD or ASC, leaving allograft costs unrecovered

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01When do I use 27415 versus 29867?

Use 27415 when the surgeon opens the joint (open arthrotomy) to place the allograft. Use 29867 when the procedure is done arthroscopically. The approach in the operative note determines the code — not the graft type.

02When do I use 27415 versus 27416?

27415 is allograft (donor tissue). 27416 is autograft (harvested from the patient, includes harvest). Confirm graft source in the operative note before selecting the code.

03Can I bill arthroscopic debridement or loose body removal on the same day as 27415?

Only if performed in a different compartment of the knee. CMS NCCI and CPT guidelines bundle diagnostic arthroscopy, chondroplasty, abrasion arthroplasty, microfracture, and OCD drilling into 27415 when done in the same compartment. Document compartment location explicitly to support separate billing with modifier 59.

04Should I append modifier 22 to 27415?

Yes, when documented work is substantially greater than typical — for example, a large or complex lesion geometry requiring significantly more graft preparation or fixation time. The operative note must quantify the additional work; modifier 22 without narrative support will be rejected.

05Does the facility need to bill a separate HCPCS code for the allograft?

Yes. Under HOPD and ASC, 27415 carries status indicator J1 as a device-intensive procedure. Bill C1889 (implantable/insertable device for device-intensive procedure) or L8699 (prosthetic implant, not otherwise specified) in addition to the CPT code to recover allograft acquisition costs.

06What ICD-10 diagnosis codes support medical necessity for 27415?

Osteochondral defect diagnoses (M93.2x series for osteochondritis dissecans, S83-range for acute traumatic chondral injury, M94.26x for chondromalacia at the knee) are typical. Payers require the diagnosis to specify a focal, full-thickness defect — a diffuse degenerative arthritis code (M17.x) alone will draw a medical necessity denial.

07What is the global period for 27415 and what does it cover?

27415 carries a 90-day global period. That covers the surgery, the day-before preoperative visit, and all routine post-op care, dressing changes, and stitch removals through day 90. Bill unrelated E/M services in the global window with modifier 24; bill related E/M visits requiring significant separate decision-making with modifier 25.

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 surgical approach (open arthrotomy), defect location and compartment, Outerbridge grade, allograft type and source, surrounding cartilage condition, knee alignment, and any concurrent procedures with their compartment location. This prevents the two most common denial triggers: missing medical necessity elements and same-compartment bundling disputes that require modifier 59 documentation to defend.

See how Mira captures CPT 27415 documentation