Revision of a total knee arthroplasty involving a single component, performed with or without the use of donor bone graft material.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $1,274.91
- Total RVUs
- 38.17
- Global, days
- 90
- Region
- Knee
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 component revised (tibial, femoral, or patellar) by name in the operative note
- State the indication for revision: aseptic loosening, polyethylene wear, instability, infection, or other failure mode
- Document whether allograft was used and, if so, the graft type, source, and how it was incorporated
- Include prior arthroplasty history: date of original implant, implant system, and any intervening procedures
- Record intraoperative findings — bone loss, cement mantle condition, component position — to support medical necessity
- Pre-operative imaging (X-ray or CT) confirming component failure or loosening should be in the record
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 6 cited references ↓
27486 covers revision of one component of a previously implanted total knee prosthesis — tibial, femoral, or patellar — with or without allograft. The surgeon removes the failed or worn component, prepares the bone bed, and implants a new prosthesis. When bone loss requires structural support, allograft is incorporated into the same procedure without a separate code.
This is a 90-day global procedure. Every routine post-op visit, wound check, and stitch removal through day 90 is bundled. Anything unrelated to the revision in that window requires modifier 24 on E/M visits or modifier 79 on unrelated procedures. An unplanned return to the OR for a related complication — infection washout, component instability — goes with modifier 78.
If two components are revised in the same session, that moves to 27487. Billing 27486 twice for a two-component revision is an NCCI violation. Document which specific component was revised; operative notes that generically state 'knee revision' without identifying the component are the top audit flag for this code.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 20.59 |
| Practice expense RVU | 13.23 |
| Malpractice RVU | 4.35 |
| Total RVU | 38.17 |
| Medicare national rate | $1,274.91 |
| 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 | $1,274.91 |
HOPD (APC 5115) Hospital outpatient department | $13,116.76 |
ASC (PI G2) Ambulatory surgical center (freestanding) | $6,804.43 |
Common denial reasons
The recurring reasons claims for CPT 27486 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Operative note does not specify which component was revised, making it impossible to confirm single-component 27486 versus two-component 27487
- Billed 27486 twice for bilateral simultaneous knee revisions without modifiers LT and RT on separate claim lines
- Missing or insufficient documentation of failed conservative or non-operative management prior to revision
- Medical necessity not established when pre-op imaging or clinical findings are absent from the record
- Routine post-op E/M visit billed in the 90-day global period without modifier 24 to indicate an unrelated diagnosis
- Allograft billed separately as an add-on when it is included in 27486 and not separately reportable
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What is the difference between 27486 and 27487?
02Is allograft billed separately when used with 27486?
03Can 27486 be billed for an isolated polyethylene liner exchange?
04How do you bill a same-day unplanned return to the OR for a complication within the 90-day global?
05What ICD-10 codes are commonly paired with 27486?
06Does 27486 require prior authorization for Medicare patients?
07How is bilateral knee revision coded on the same date?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57685
- 03aahks.orghttps://www.aahks.org/wp-content/uploads/2018/08/ICD10-codes-27486-27487.pdf
- 04cms.govhttps://www.cms.gov/files/document/04-chapter4-ncci-medicare-policy-manual-2025finalcleanpdf.pdf
- 05cgsmedicare.comhttps://www.cgsmedicare.com/medicare_dynamic/j15/partb/ptpb/ptp.aspx
- 06aahks.orghttps://www.aahks.org/practice-resources/coding-resource-center/
Mira AI Scribe
Mira's AI scribe captures the specific component revised (tibial insert/tray, femoral component, or patellar button), the failure mode from surgeon dictation (loosening, wear, instability, periprosthetic fracture), allograft use and type, and prior arthroplasty dates. That detail prevents the most common 27486 audit flag — an operative note that says 'knee revision' without confirming single-component revision, which auditors use to downcode or deny the claim outright.
See how Mira captures CPT 27486 documentation