Open surgical reduction of a dislocated knee joint with internal fixation when needed, performed without primary ligament repair or ligamentous reconstruction.
Verified May 8, 2026 · 7 sources ↓
- Medicare
- $798.62
- Total RVUs
- 23.91
- 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 7 cited references ↓
- Operative note must state the mechanism and direction of dislocation (anterior, posterior, lateral, medial, rotatory).
- Explicitly document that no primary ligamentous repair or augmentation/reconstruction was performed — absence of this statement invites upcoding scrutiny.
- Record neurovascular status pre- and post-reduction, including ABI or vascular surgery consultation if performed.
- Specify whether internal fixation was used; if so, document hardware type, size, and placement site.
- Document staged reconstruction plan if ligament repair is deferred, to support medical necessity for the limited scope of 27556.
- Include intraoperative fluoroscopy or imaging confirmation of reduction if obtained.
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 7 cited references ↓
CPT 27556 covers open treatment of a knee dislocation — including internal fixation when used — where the surgeon does not perform any primary ligamentous repair or augmentation/reconstruction at the same operative session. This distinguishes it from 27557 (with primary ligamentous repair) and 27558 (with repair plus augmentation/reconstruction). Choose the code that matches what was actually done to the ligaments; upcoding to 27557 or 27558 when only bony reduction and fixation were performed is an audit target.
Knee dislocations are high-energy injuries frequently involving multiligamentous disruption, vascular injury, and neurovascular compromise. When the operative plan addresses only the osseous dislocation — staged ligament reconstruction is deferred, or the ligaments were intact enough not to require repair — 27556 is the correct primary code. Internal fixation hardware (pins, screws) used to stabilize the reduction is included and not separately reportable.
The 90-day global period means all routine post-op care through day 90 is bundled. Unrelated E/M services in that window require modifier 24. If a complication requires a return to the OR for a related procedure (e.g., hardware adjustment), use modifier 78. An unrelated surgical problem addressed in the global period uses modifier 79.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 12.68 |
| Practice expense RVU | 8.53 |
| Malpractice RVU | 2.7 |
| Total RVU | 23.91 |
| Medicare national rate | $798.62 |
| 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 | $798.62 |
HOPD (APC 5114) Hospital outpatient department | $7,413.38 |
ASC (PI G2) Ambulatory surgical center (freestanding) | $3,695.53 |
Common denial reasons
The recurring reasons claims for CPT 27556 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Code billed as 27557 or 27558 when operative note describes only bony reduction without documented ligament repair — or vice versa, 27556 billed when ligament repair was actually performed.
- Missing documentation of ligamentous management (repair vs. deferred) causes payer to downcode or deny for insufficient operative detail.
- Global period violations: E/M or follow-up visits billed within 90 days without modifier 24, triggering automatic denial.
- Laterality not specified on the claim; payers requiring LT/RT modifier will reject without it.
- Medical necessity denied when the operative report does not document neurovascular status or imaging confirming true dislocation versus subluxation.
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 7 cited references ↓
01What separates 27556 from 27557 and 27558?
02Can 27556 be billed with a ligament reconstruction code at the same session?
03Is staged ligament reconstruction after 27556 billable separately?
04Does 27556 require a specific place of service?
05Can modifier 22 be used with 27556?
06When is modifier 62 appropriate for this procedure?
07Does 27556 cover a dislocated knee prosthesis?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02fastrvu.comhttps://fastrvu.com/cpt/27556
- 03cms.govhttps://www.cms.gov/files/document/r13573cp.pdf
- 04abos.orghttps://www.abos.org/wp-content/uploads/2019/12/sports-cpt-updated.pdf
- 05aapc.comhttps://www.aapc.com/codes/cpt-codes/27556
- 06findacode.comhttps://www.findacode.com/cpt/27556-cpt-code.html
- 07acgme.orghttps://www.acgme.org/globalassets/pfassets/programresources/269_caselogguidelines_orthopaedictrauma.pdf
Mira AI Scribe
Mira's AI scribe captures the specific direction of dislocation, intraoperative ligamentous findings (intact vs. disrupted), the decision not to perform primary repair or reconstruction, hardware used for fixation, and pre/post-reduction neurovascular status. That documentation directly prevents downcoding to closed treatment codes and shields against upcoding allegations when 27557 or 27558 were not warranted.
See how Mira captures CPT 27556 documentation