Revision total knee arthroplasty with replacement of both the femoral and tibial components, with or without the use of allograft tissue.

Verified May 8, 2026 · 9 sources ↓

Medicare: $1,574.52
Total RVUs: 47.14
Global, days: 90
Region: Knee

Drawn from CMSMassAAHKSAAOS

Documentation requirements

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

Source · Editorial brief grounded in 9 cited references ↓

Specify that BOTH femoral and tibial components were revised — use of 27487 requires documentation of dual-component revision, not single-component.
Document the failure mode or indication for revision (e.g., aseptic loosening, instability, polyethylene wear, periprosthetic fracture, infection) with supporting imaging or lab findings.
Record the prior implant system, including manufacturer and component type if available, to establish revision necessity.
Note whether allograft was used and, if so, the graft type and source — the code allows for but does not require allograft.
Include conservative or non-operative measures attempted or the reason they were not appropriate, per LCD medical necessity requirements.
Document the surgical approach by name; operative notes that reference only 'standard approach' are flagged during audit.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 51 Multiple procedures 57 Decision for surgery 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 9 cited references ↓

CPT 27487 covers revision knee arthroplasty in which both the femoral and tibial components are removed and replaced. This is the higher-complexity revision code — use it when both components are being revised. If only one component is addressed, 27486 applies instead. The distinction between 27486 and 27487 determines which ICD-10-CM code group supports medical necessity; CMS billing and coding articles for revision TKA specifically split diagnoses between these two codes.

The 90-day global period applies. Every routine post-op visit, wound check, and stitch removal through day 90 is bundled. Modifier 24 is required for unrelated E/M services during that window; modifier 78 covers an unplanned return to the OR for a procedure related to the original revision. If the surgeon anticipates a staged return — for example, reimplantation after a two-stage revision for infection — document that intent in the original operative note and append modifier 58, which resets the global clock.

Many payers, including Medicaid programs such as MassHealth, require prior authorization for 27487. Commercial payers often apply their own LCD-aligned criteria for revision indications. Failure mode, component failure documentation, and prior implant details must be in the operative note — not just the pre-op note. CMS OIG has included 27487 in total knee arthroplasty medical necessity and documentation audits (0185), so the record must independently support both the indication for revision and the specific components revised.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	26.43
Practice expense RVU	15.11
Malpractice RVU	5.6
Total RVU	47.14
Medicare national rate	$1,574.52
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	$1,574.52
HOPD (APC 5116) Hospital outpatient department	$17,913.59
ASC (PI J8) Ambulatory surgical center (freestanding)	$13,964.28

Common denial reasons

The recurring reasons claims for CPT 27487 get rejected.

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

27487 billed when only one component was revised — use 27486 for single-component revision; payers will downcode or deny if documentation doesn't support bilateral component involvement.
ICD-10-CM diagnosis code not drawn from the Group 4 revision-specific code set recognized by CMS for 27486/27487 — primary TKA diagnosis codes do not support revision claims.
Missing or inadequate prior authorization from payers that require PA for knee arthroplasty services, including several Medicaid programs.
Insufficient documentation of medical necessity — no imaging, lab results, or clinical findings establishing component failure or other revision indication.
E/M service billed in the 90-day global period without modifier 24, triggering automatic bundling denial.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 9 cited references ↓

01What is the difference between 27486 and 27487?

27486 covers revision of a single component — either femoral or tibial. 27487 requires revision of both the femoral and tibial components. CMS billing and coding articles assign separate ICD-10-CM diagnosis code groups to each; using the wrong code against the wrong diagnosis group is a direct denial trigger.

02Can 27487 be billed with allograft codes on the same claim?

The code description allows for allograft use as part of the revision. Whether separate graft codes are additionally billable depends on NCCI edits and payer policy — check current NCCI tables before appending graft procurement or application codes.

03How do you handle a two-stage revision for periprosthetic joint infection?

The explant stage and the reimplantation stage are billed separately. Document the staged plan in the first operative note and append modifier 58 to the reimplantation procedure. Modifier 58 resets the 90-day global and signals a planned staged procedure, not a complication.

04Is prior authorization required for 27487?

Yes for many payers. MassHealth requires PA for 27487 effective June 2018. Most commercial payers and some other Medicaid programs have similar requirements. Verify PA status before scheduling; a missing PA is not fixable on appeal after the date of service.

05What modifier applies if the surgeon returns to the OR within the global period for a related complication?

Modifier 78 — unplanned return to the OR during the global period for a procedure related to the original surgery. Do not use modifier 79 for related procedures; 79 is reserved for unrelated procedures performed during the global period.

06Does modifier 22 apply to 27487 for unusually complex revisions?

Yes, when the work is substantially greater than typical — for example, severe bone loss requiring structural allograft, hardware removal complicating exposure, or significant scarring from prior surgeries. The operative note must describe the specific factors that increased time and complexity; a generic 'difficult case' notation will not survive audit.

07What CMS audit activity targets 27487?

CMS OIG review 0185 specifically lists 27487 among affected codes for total knee arthroplasty medical necessity and documentation requirements audits. Records must independently support the indication and document the components revised — not just reference the pre-op plan.

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 components revised (femoral, tibial, or both), the documented failure mode or revision indication, implant details, approach, and whether allograft was used — all directly from dictation. This prevents the most common 27487 denial: a claim for dual-component revision without operative documentation that clearly distinguishes the case from a single-component 27486 procedure.

See how Mira captures CPT 27487 documentation