Open osteochondral autograft transplantation of the knee, including harvesting of the autograft(s) — commonly performed as mosaicplasty (OATS).

Verified May 8, 2026 · 6 sources ↓

Medicare: $902.49
Total RVUs: 27.02
Global, days: 90
Region: Knee

Drawn from CMSAetnaAAPCAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm open approach — note incision through skin and synovium with direct joint visualization; 'arthroscopic portals only' routes to 29866, not 27416
Identify defect location (compartment, articular surface) and size in mm or cm² — patellar defects are excluded by multiple payer policies
Document harvest site within the knee (low-load-bearing zone) and confirm autograft origin — allograft tissue routes to 27415
Specify number and diameter of osteochondral plugs harvested and implanted; mosaicplasty pattern description strengthens audit defense
Record the underlying diagnosis (e.g., osteochondritis dissecans, traumatic chondral defect) with corresponding ICD-10 code to satisfy medical necessity criteria
Note absence of synthetic resorbable polymer implants if applicable — their use is a payer exclusion under multiple coverage policies

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 78 Unplanned return — related 79 Unrelated during global AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

27416 covers an open procedure in which the surgeon harvests one or more cylindrical osteochondral plugs from a low-load-bearing zone of the patient's own knee and press-fits them into a prepared cartilage defect — the mosaic pattern gives mosaicplasty its name. Because harvesting is included in the code descriptor, do not separately bill a graft-harvest code. The open approach is the defining feature: the surgeon incises through skin and synovium to gain direct visualization of the defect. If the surgeon instead uses arthroscopic portals only, bill 29866.

The code carries a 90-day global period. All routine post-op visits, wound checks, and dressing changes through day 90 are bundled. CPT guidelines prohibit reporting 27416 with 27415 (open osteochondral allograft) at the same session. Within the same compartment, do not stack 27416 with 29874, 29877, 29879, or 29885–29887. At the same session, do not report with 29870, 29871, 29875, or 29884. NCCI reinforces these exclusions.

Prior authorization is required by multiple major payers including Humana and Point32 for osteochondral cartilage procedures. Aetna covers 27416 per its clinical policy bulletin when selection criteria are met, but explicitly excludes patellar chondral defect repair and synthetic resorbable polymer implants. Document the defect location precisely — patellar lesions will trigger denial under policies that follow Aetna's criteria.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	13.81
Practice expense RVU	10.27
Malpractice RVU	2.94
Total RVU	27.02
Medicare national rate	$902.49
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	$902.49
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 27416 get rejected.

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

Patellar defect location — Aetna and similar payer policies explicitly exclude 27416 for patellar chondral repairs; expect denial without on-label indication
Missing or inadequate prior authorization — Humana, Point32, and other payers require pre-auth for osteochondral cartilage surgery; submitting without it results in automatic denial
Unbundling of graft harvest — separately billing a harvest code alongside 27416 triggers NCCI edits because harvesting is already included in the descriptor
Wrong code for approach — billing 27416 when the operative note documents arthroscopic portals without open incision; payers audit for open-approach documentation
Stacking prohibited same-session codes — reporting 27416 with 27415 or same-compartment arthroscopy codes (29874, 29877, 29879) violates CPT guidelines and NCCI edits

Frequently asked questions

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

01What is the difference between 27416 and 29866?

Approach is the deciding factor. 27416 is open: the surgeon incises skin and synovium for direct access. 29866 is arthroscopic. Using the wrong code for the documented approach is an audit red flag and a common denial trigger.

02What is the difference between 27416 and 27415?

Graft source. 27416 uses autograft — tissue harvested from the patient's own knee. 27415 uses allograft — donor tissue. CPT prohibits reporting both at the same session. The operative note must clearly identify the graft source.

03Is graft harvesting separately billable when reporting 27416?

No. Harvesting of the autograft is explicitly included in the 27416 descriptor. Billing a separate harvest code alongside it will hit NCCI edits and trigger a denial or recoupment.

04Does 27416 require prior authorization?

For most commercial payers — yes. Humana, Point32 Health, and several regional plans require prior authorization for osteochondral cartilage procedures. Verify PA requirements before scheduling; late authorization requests are routinely denied.

05Can 27416 be billed for a patellar cartilage defect?

Not under payers following Aetna's clinical policy bulletin or similar criteria — patellar chondral defect repair is an explicit exclusion. Confirm defect location in the op note and check the applicable payer's medical policy before billing.

06What is the global period for 27416, and what does it cover?

90-day global. Routine post-op office visits, wound checks, and stitch removals through day 90 are bundled. Bill modifier 24 for unrelated E/M visits and modifier 78 for an unplanned return to the OR for a related complication during the global window.

07Which arthroscopy codes are excluded when billing 27416?

At the same session: do not report 29870, 29871, 29875, or 29884. In the same compartment: do not report 29874, 29877, 29879, or 29885–29887. These exclusions come from CPT guidelines and are reinforced by NCCI edits.

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 incision with synovial entry and direct joint visualization), defect compartment and surface, plug count and diameter, and harvest site from the surgeon's dictation. It flags automatically when documentation references only arthroscopic portals — which would route the claim to 29866 — and when the defect is patellar, triggering a prior-auth and coverage alert before the claim is submitted.

See how Mira captures CPT 27416 documentation