Arthroplasty of the femoral condyles or tibial plateau(s) of the knee, performed with debridement and partial synovectomy.

Verified May 8, 2026 · 6 sources ↓

Medicare: $761.87
Total RVUs: 22.81
Global, days: 90
Region: Knee

Drawn from CMSZimmerbiometAAPCFindacodeAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify the specific anatomic target(s): femoral condyle(s), medial tibial plateau, lateral tibial plateau, or combination
Confirm both debridement and partial synovectomy were actively performed, not just incidentally noted in the operative report
Document the extent of articular cartilage defects, including lesion size and location, to support medical necessity
Record implant type, size, and fixation method (cemented vs. uncemented) if a prosthetic component is placed
Note the surgical approach by name (e.g., medial parapatellar, subvastus, midvastus) — 'standard approach' flags audits
Include the diagnosis with ICD-10-CM code confirming unicompartmental pathology that does not meet criteria for total knee arthroplasty

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 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27443 covers resurfacing or reconstructing defects of the femoral condyles or tibial plateau(s) — a unicompartmental-level procedure — combined with joint debridement and partial synovectomy performed in the same operative session. It sits within the 27440–27447 partial and unicompartmental arthroplasty family, one step below the single-compartment condyle-and-plateau code (27446) and well below total knee arthroplasty (27447). The debridement and partial synovectomy components are bundled into 27443 by definition; do not report them separately.

The 90-day global period applies. That window covers the day-before visit, the surgery, and all routine post-operative management through day 90 — dressing changes, suture removal, and standard follow-up. Bill unrelated E/M visits in the global window with modifier 24; unrelated surgical procedures with modifier 79. A staged or planned related procedure in the global period requires modifier 58; an unplanned return to the OR for a related complication uses modifier 78.

This code is structurally similar to 27442 (same anatomic targets, no debridement/synovectomy) and is frequently confused with it at coding review. The operative note must confirm that debridement and partial synovectomy were both performed — not merely mentioned as incidental findings — or the payer will downcode to 27442.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	11.12
Practice expense RVU	9.32
Malpractice RVU	2.37
Total RVU	22.81
Medicare national rate	$761.87
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	$761.87
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$10,208.40

Common denial reasons

The recurring reasons claims for CPT 27443 get rejected.

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

Downcoding to 27442 when the operative note fails to explicitly document that debridement and partial synovectomy were performed
Medical necessity denial when documentation does not distinguish why a partial/condylar procedure was chosen over total knee arthroplasty
Unbundling denial if debridement or synovectomy is billed separately — both are included components of 27443
Global period violation when post-op E/M visits are billed without modifier 24 confirming an unrelated reason for the encounter
ICD-10-CM mismatch when a bilateral diagnosis code is used without modifier 50 or bilateral claim submission per payer instructions

Frequently asked questions

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

01What is the difference between 27442 and 27443?

Both cover arthroplasty of the femoral condyles or tibial plateau(s), but 27443 specifically includes debridement and partial synovectomy. If those steps aren't documented as actively performed, the claim will be downcoded to 27442.

02Can I bill the debridement separately in addition to 27443?

No. Debridement and partial synovectomy are bundled components of 27443 by code definition. Billing them separately will trigger an NCCI bundling denial.

03How does the 90-day global period affect post-op billing?

All routine post-operative care through day 90 is included. Use modifier 24 on E/M visits that are for an unrelated condition, modifier 79 for an unrelated surgical procedure, and modifier 78 for an unplanned return to the OR for a complication related to the original procedure.

04How should I bill if 27443 is performed bilaterally in the same session?

Payer rules vary. Most Medicare contractors accept a single line with modifier 50; some private payers require two lines with LT and RT. Confirm with each payer's specific bilateral billing instructions before submission.

05When is modifier 22 appropriate for 27443?

Use modifier 22 when the procedure required substantially increased physician work — for example, severe deformity, prior surgical scarring, or unusual complexity not captured by the base code. Attach a cover letter quantifying the added time and effort; documentation must support it.

06Is 27443 appropriate for a patient who already had a total knee replacement?

No. Revision of a previously implanted total knee prosthesis uses 27486 or 27487. CPT 27443 applies to primary arthroplasty of isolated femoral condyle or tibial plateau defects, not revision of a prior total knee system.

07What site of service considerations apply to 27443?

27443 carries HOPD and ASC payment rates — see the Site of Service comparison table on this page. The code has OPPS status indicator J1 and APC 5115 in the hospital outpatient setting.

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 anatomic targets (femoral condyle vs. medial or lateral tibial plateau), confirms both debridement and partial synovectomy are dictated as active surgical steps — not passive observations — and records implant details, fixation method, and approach by name. That documentation prevents the single most common denial for this code: downcoding to 27442 because the operative note left the debridement and synovectomy components ambiguous or unlisted.

See how Mira captures CPT 27443 documentation