Surgical reconstruction of the tibial component of the knee joint to relieve pain and restore function in patients with a damaged or deteriorated knee.

Verified May 8, 2026 · 7 sources ↓

Medicare: $745.84
Total RVUs: 22.33
Global, days: 90
Region: Knee

Drawn from CMSMdclarityAAPCAAOS

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify the prior knee procedure that necessitates revision, including date and CPT code of original surgery.
Document the tibial component pathology by name — loosening, wear, infection, malalignment — with imaging correlation.
Operative note must identify the specific tibial structures reconstructed or replaced, not just 'revision of knee.'
Record intraoperative findings that confirm the tibial-sided nature of the revision to support code selection over full revision arthroplasty codes.
Include pre-operative functional status, pain scores, and conservative treatment failure to establish medical necessity.
Document implant manufacturer, model, and lot number for any tibial hardware placed or exchanged.

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 58 Staged or related 59 Distinct service 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 ↓

CPT 27440 covers open surgical revision of the knee joint, specifically targeting the tibial side of the joint. This is used when prior knee surgery — including joint replacement — has resulted in complications such as component loosening, wear, or infection requiring formal reconstruction of the tibial articulation. The procedure is distinct from full revision arthroplasty codes and should be selected when the operative work is limited to the tibial compartment rather than a complete multi-component exchange.

The 90-day global period means all routine post-operative care, follow-up visits, dressing changes, and stitch removal from the day before surgery through day 90 are bundled into the payment. Any visit for a problem unrelated to the knee revision requires modifier 24 (E/M) or modifier 25 (same-day E/M before surgery). A staged related procedure performed within the global window requires modifier 58; an unplanned return for a complication of this surgery requires modifier 78.

Site of service matters significantly for this code. HOPD and ASC payments differ substantially — see the Site of Service comparison table on this page. Payers vary on whether prior authorization is required for revision versus primary procedures; confirm this before scheduling, as authorization gaps are a leading non-clinical denial driver for this code family.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.81
Practice expense RVU	9.21
Malpractice RVU	2.31
Total RVU	22.33
Medicare national rate	$745.84
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	$745.84
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$8,621.29

Common denial reasons

The recurring reasons claims for CPT 27440 get rejected.

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

Insufficient documentation distinguishing tibial-component-specific revision from a complete knee revision arthroplasty — payers may demand upcoding justification or downcode to a lesser procedure.
Missing prior authorization when payer policy requires separate auth for revision versus primary knee procedures.
Global period conflict — same-surgeon E/M visit billed within the 90-day global without modifier 24 or 25.
ICD-10 diagnosis code does not clearly indicate a prior knee implant complication (e.g., T84.0xx series for mechanical complication of internal joint prosthesis) — mismatched diagnosis is a top NCCI-related denial trigger.
Modifier 78 missing when patient returns to OR within global period for a complication directly related to this procedure.

Frequently asked questions

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

01How does 27440 differ from the full knee revision arthroplasty codes like 27487?

27440 is specific to reconstruction of the tibial component of the knee joint. Full revision arthroplasty codes such as 27487 cover removal and replacement of both femoral and tibial components. If the surgeon is working on both components, do not use 27440 — select the appropriate full revision code. Miscoding this distinction is an audit risk.

02What ICD-10 codes support medical necessity for 27440?

The T84.0xx series (mechanical complications of internal joint prostheses) is the primary supporting diagnosis family. T84.010–T84.019 cover loosening, T84.030–T84.039 cover mechanical breakage, and M16.1x/M17.1x primary osteoarthritis codes are generally insufficient alone — you need a complication or failure code tied to the prior procedure.

03Can 27440 be billed with an E/M visit on the same day?

Yes, but only with modifier 25 on the E/M, and only if the evaluation is a separately identifiable service beyond the routine pre-op assessment. If the visit is just confirming the surgical plan, it does not qualify for a separate E/M.

04If the patient returns to the OR within 90 days for a complication of this revision, which modifier applies?

Modifier 78 — unplanned return to the operating room for a procedure related to the original surgery. Do not use modifier 79 for this scenario. Modifier 79 is for a return to the OR for a procedure unrelated to the original surgery.

05Is 27440 performed bilaterally in practice, and how is that billed?

Bilateral tibial knee revisions in the same session are rare but possible. Bill with modifier 50, list the procedure once, and confirm the payer's bilateral payment policy — many apply a 150% rule (100% for the first side, 50% for the second).

06Does the 90-day global include management of a post-op wound infection?

Routine wound care is bundled. However, if the infection requires a return to the OR or a separately identifiable service beyond standard post-op management, that can be billed outside the global with the appropriate modifier (58 for a staged related procedure, 78 for unplanned OR return for a complication).

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 specific tibial pathology (loosening, wear, infection, malalignment), the prior knee procedure history with dates, intraoperative findings confirming tibial-sided involvement, implant details, and the approach used. This prevents the most common audit flag for 27440: an operative note that documents a generic 'revision' without supporting the tibial-component-specific code selection over full revision arthroplasty alternatives.

See how Mira captures CPT 27440 documentation