Removal of a knee prosthesis — including total knee components and methylmethacrylate cement — with or without insertion of a spacer at the same operative session.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,099.89
Total RVUs: 32.93
Global, days: 90
Region: Knee

Drawn from CMSAAPCMdclarityZimmerbiometNIH

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Operative note must identify all components removed (femoral, tibial, patellar) and whether methylmethacrylate cement was present and excised
Document the indication for removal — infection with culture data, aseptic loosening with imaging correlation, or other implant failure mechanism
If a spacer is inserted, specify spacer type (static vs. articulating), antibiotic composition, and fixation method
Confirm no permanent prosthesis was implanted at this encounter — any exchange of a permanent component shifts coding to 27486 or 27487
For two-stage infection protocol, label this operative note as Stage 1 and link it to the treating diagnosis (e.g., T84.5XXA periprosthetic infection)
Record laterality (right vs. left knee) explicitly in both the operative note and the procedure order

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 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 27488 covers surgical removal of a knee prosthesis, including total knee implant systems and methylmethacrylate cement, with or without concurrent placement of an antibiotic-impregnated or articulating spacer. It is the correct code for Stage 1 of a two-stage revision protocol for periprosthetic joint infection (PJI), where the implant is explanted and a spacer is inserted before subsequent reimplantation. The code also applies to non-staged removals where reimplantation is not planned or is deferred indefinitely.

Distinguishing 27488 from the revision codes (27486, 27487) is the most common coding decision point. If components are being exchanged — even one — the revision codes apply. 27488 is removal only, with or without a spacer; no new permanent prosthesis is implanted at the same encounter. CMS treats 27488 as an inpatient-only procedure under OPPS (status indicator C), so hospital outpatient and ASC billing does not apply for Medicare beneficiaries; HOPD and ASC payment figures are relevant only for non-Medicare payers.

The 90-day global period means the operative day plus 89 postoperative days are bundled. Any same-surgeon service in that window for a reason related to the removal — wound checks, spacer adjustments — is not separately billable. Services for unrelated conditions require modifier 79; a return to the OR for a related complication requires modifier 78. If Stage 2 reimplantation (27447 or similar) follows within the global window as planned, append modifier 58 to the reimplantation 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	17.16
Practice expense RVU	12.14
Malpractice RVU	3.63
Total RVU	32.93
Medicare national rate	$1,099.89
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	$1,099.89
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$9,493.97

Common denial reasons

The recurring reasons claims for CPT 27488 get rejected.

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

Upcoded to a revision code (27487) by the payer when documentation doesn't clearly distinguish removal-only from component exchange
Medicare OPPS/ASC site-of-service denial — 27488 is an inpatient-only procedure under CMS OPPS status indicator C; billing in an outpatient facility for a Medicare patient triggers automatic rejection
Missing or ambiguous laterality — LT/RT modifier absent or contradicted by the operative note
Global period conflict — post-removal services billed without modifier 78 or 79 when a prior related procedure's global is still open
Incorrect staging modifier — Stage 2 reimplantation billed without modifier 58 when performed within the 90-day global of the 27488 removal encounter

Frequently asked questions

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

01What is the difference between 27488 and 27487?

27487 is a revision — at least the femoral and entire tibial components are exchanged for new permanent implants at the same session. 27488 is removal only, with or without a spacer. If any permanent prosthesis goes in, you're in revision territory. If the surgeon explants everything and places an antibiotic spacer pending a clean reimplantation, bill 27488.

02Can 27488 be billed in an ASC for Medicare patients?

No. CMS assigns 27488 OPPS status indicator C (inpatient only). Performing this on a Medicare patient in an outpatient hospital or ASC setting will result in a site-of-service denial. Commercial payers may differ — verify each contract separately.

03Which modifier applies when Stage 2 reimplantation follows within the 90-day global?

Modifier 58 on the reimplantation code (e.g., 27447). It signals a staged procedure related to the original surgery, which is expected and planned — not a complication. Without 58, the reimplantation will deny as bundled into the global of the 27488 encounter.

04Should modifier 22 be appended for heavily infected or cemented cases requiring extensive debridement?

Only if the operative work was substantially greater than typical — extensive cement removal, multiple debridement layers, or prolonged operative time with clear documentation. The note must quantify the additional effort. Using modifier 22 routinely or twice on the same claim draws audit scrutiny.

05How does 27488 interact with a same-day arthroscopy or debridement code?

Bundling rules generally preclude separate payment for debridement codes performed in the same joint at the same session as 27488. Append modifier 51 on the lower-valued code if a truly separate and distinct procedure is performed, but verify NCCI edits first — many knee arthroscopy codes are bundled with 27488 and modifier 51 alone won't override a column-one/column-two edit.

06What ICD-10 diagnosis codes pair most commonly with 27488?

Periprosthetic joint infection maps to T84.5XXA (initial) or T84.5XXD (subsequent encounter). Aseptic loosening uses T84.033A or T84.038A depending on the component. Mechanical failure codes (T84.09XA) apply when the indication is implant fracture or dislocation rather than infection. Accurate diagnosis coding is essential because payers scrutinize the clinical rationale for explantation.

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 components explanted (femoral, tibial, patellar), cement presence and removal, spacer type and antibiotic load, and the clinical indication (infection versus aseptic loosening) directly from dictation. It flags the encounter as Stage 1 when a spacer is placed without a permanent reimplant, preventing the operative note from being miscoded as a revision (27486/27487) during audit review.

See how Mira captures CPT 27488 documentation