Arthroscopy · Knee

Arthroscopic surgical transplantation of donor (allograft) osteochondral tissue into a damaged articular cartilage surface of the knee joint.

Verified May 8, 2026 · 8 sources ↓

Medicare: $1,178.72
Total RVUs: 35.29
Global, days: 90
Region: Knee

Drawn from CMSAAPCElitelearningMcwebJposna

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Operative note must identify the specific compartment (medial femoral condyle, lateral femoral condyle, patella, trochlea) where the allograft was implanted.
Document defect size (cm²) — payers use this to verify medical necessity thresholds and allograft sizing.
Confirm donor allograft source and that no autograft harvest was performed (distinguishes 29867 from 29866).
Record prior conservative treatments tried and failed (PT, injections, activity modification) to support medical necessity.
If modifier 22 is appended, the operative note must explicitly detail factors making the work substantially greater than typical — defect complexity, graft fit difficulty, or patient anatomy.
For same-session companion procedures in a different compartment, document each compartment addressed and the distinct pathology in each.
Pre-op MRI or imaging report confirming focal cartilage defect size and location should be in the chart at the time of billing.

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 59 Distinct service 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 8 cited references ↓

CPT 29867 covers arthroscopic implantation of an osteochondral allograft — donor-sourced cartilage and underlying bone — into a defect on the articular surface of the knee. The procedure is used when focal full-thickness cartilage loss has caused pain and loss of motion that conservative treatment has not resolved. Unlike 29866, no autograft harvest is required; the surgeon works entirely with processed donor tissue. Per CPT Assistant (December 2008), 29867 may also be reported when synthetic osteochondral plugs (e.g., synthetic mosaicplasty) are used in the knee, even though the descriptor specifies allograft.

This code carries a 90-day global period. All routine postoperative visits, wound checks, and dressing changes through day 90 are bundled. Return-to-OR services during that window require modifier 78 (unplanned, related) or 79 (unrelated). Companion procedures performed in a different compartment of the same knee the same day can be separately reported using modifier 59 to establish distinct procedural service. 29867 is not separately reportable with open osteochondral allograft transplantation (27415) — payers treat those as duplicative.

Payer prior-authorization requirements are nearly universal for 29867. Most payers require documented failure of conservative management, MRI or imaging confirming the defect size and location, and evidence that the patient is skeletally mature or near-mature. ASC facility payment is substantially lower than HOPD; site-of-service selection affects total case economics meaningfully.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	17.93
Practice expense RVU	13.53
Malpractice RVU	3.83
Total RVU	35.29
Medicare national rate	$1,178.72
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	$1,178.72
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$8,621.29

Common denial reasons

The recurring reasons claims for CPT 29867 get rejected.

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

Missing or insufficient prior authorization — most commercial and Medicare Advantage payers require pre-auth for osteochondral allograft procedures.
Bundling with 27415 (open osteochondral allograft transplantation): payers deny 29867 when 27415 is billed the same day, treating them as duplicative services.
Medical necessity not established — no documented failure of conservative management or imaging confirming defect prior to surgery.
Modifier 59 missing when a companion arthroscopic procedure is billed for a different compartment same day, triggering NCCI bundle denial.
Defect size or patient age outside payer coverage criteria — some payers exclude skeletally immature patients or very large defects from allograft coverage.
Global period violation — post-op E/M visits billed without modifier 24 during the 90-day global period.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01Can 29867 and 27415 be billed together on the same date of service?

No. Payers — including Medi-Cal by policy — treat 29867 (arthroscopic allograft) and 27415 (open osteochondral allograft transplantation) as mutually exclusive. Billing both for the same knee same day will result in denial of one. Use whichever code reflects the actual technique performed.

02When can synthetic osteochondral plugs be billed under 29867?

Yes — per CPT Assistant (December 2008), 29867 is the correct code when synthetic plugs are used for arthroscopic osteochondral grafting of the knee, even though the descriptor says allograft. This guidance is knee-specific; for the ankle, use an unlisted code instead.

03What modifier is needed if a meniscectomy is performed in the medial compartment and the allograft is placed in a different compartment the same day?

Append modifier 59 to the lower-valued code to identify it as a distinct procedure performed in a separate compartment. Document both compartments explicitly in the operative note.

04Does 29867 require prior authorization?

For virtually all commercial payers and Medicare Advantage plans, yes. Authorization criteria typically include documented conservative treatment failure, imaging-confirmed focal cartilage defect, and skeletal maturity. Obtain auth before scheduling and retain the approval number in the chart.

05How is the 90-day global period handled if the patient needs a second knee procedure?

If the return procedure is related to the original allograft surgery — such as a complication or incomplete healing requiring revision — use modifier 78. If the second procedure is for a completely unrelated condition in the same or opposite knee, use modifier 79. Do not use 78 and 79 interchangeably; payers audit this distinction.

06Can 29867 be reported bilaterally with modifier 50?

Technically yes if osteochondral allograft implantation is genuinely performed on both knees in the same operative session, but bilateral OCA transplantation is rare. Expect heightened scrutiny — document bilateral pathology clearly and expect payers to request the operative report before paying.

07Is a pre-operative E/M visit separately billable before 29867?

Yes, if the visit is the decision-making encounter for surgery. Append modifier 57 to the E/M when the decision to perform 29867 is made at that visit. Routine consent or H&P visits where no medical decision-making occurs are not separately reimbursable.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures compartment location (medial femoral condyle, lateral femoral condyle, patella, or trochlea), defect size in cm², confirmation that donor allograft — not autograft — was used, graft fit and fixation technique, and any companion procedures with their respective compartments. That specificity closes the documentation gaps that drive medical-necessity denials and prevents the 29866-vs-29867 mix-up that auditors flag routinely.

See how Mira captures CPT 29867 documentation