Arthroscopy · Knee

Knee arthroscopy performed surgically with lateral retinacular release to address lateral compartment tightness or patellar malalignment.

Verified May 8, 2026 · 6 sources ↓

Medicare: $521.05
Total RVUs: 15.6
Global, days: 90
Region: Knee

Drawn from CMSAAPCPriorityhealthCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify laterality (right or left knee) in the operative note and on the claim
Document the medical necessity for lateral release — e.g., lateral patellar compression syndrome, patellar tilt, or tracking dysfunction confirmed on exam or imaging
If billing a second arthroscopic code (e.g., G0289 for chondroplasty), document the separate compartment in which that procedure was performed
Record the specific technique of the lateral release (arthroscopic electrocautery, shaver, or blade) and extent of release performed
Document failure of conservative treatment (physical therapy, bracing, NSAIDs) to establish medical necessity before surgery
Include pre-op diagnosis, intraoperative findings, and post-op diagnosis as discrete elements in the operative report

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

LT Left side RT Right side 50 Bilateral procedure 59 Distinct service 22 Increased complexity 51 Multiple procedures 78 Unplanned return — related 79 Unrelated during global 76 Repeat, same physician

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 29873 describes a surgical knee arthroscopy in which the lateral retinaculum is released under arthroscopic visualization. The procedure is used for lateral patellar compression syndrome, patellar tilt, or other conditions where excessive lateral soft-tissue tension contributes to anterior knee pain or patellar tracking dysfunction. It carries a 90-day global period, meaning all routine post-op care through day 90 is bundled into the payment.

Not all add-on procedures can be stacked onto 29873. NCCI pairs 29873 with 29874 and 29877 under a modifier indicator of '0' — meaning those combinations cannot be bypassed with a modifier for Medicare. When chondroplasty (typically reported via G0289 for Medicare) or loose body removal is performed with 29873, it must occur in a separate compartment and must be independently documented to justify separate billing. CPT rules differ slightly from Medicare NCCI rules here, so know which payer you're billing before adding a second arthroscopic code.

29875 (limited synovectomy) cannot be reported with any other arthroscopic knee procedure on the ipsilateral knee regardless of payer. Diagnostic arthroscopy (29870) is always bundled into 29873 and cannot be billed separately. Laterality must be documented and reflected in the ICD-10 diagnosis code; Priority Health and most commercial payers require right/left specificity in both the operative note and the claim.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.08
Practice expense RVU	8.26
Malpractice RVU	1.26
Total RVU	15.6
Medicare national rate	$521.05
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	$521.05
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 29873 get rejected.

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

Billing 29874 or 29877 alongside 29873 on the same knee — both pairs carry a modifier indicator of '0' under NCCI, so no modifier can bypass the edit
Missing or non-specific laterality: ICD-10 code reported without right/left designation when the operative note specifies a side
Billing 29875 (limited synovectomy) on the same claim for the ipsilateral knee — NCCI prohibits this combination regardless of modifier
Reporting diagnostic arthroscopy 29870 separately — it is always bundled into surgical arthroscopy codes including 29873
Lack of documented conservative treatment failure prior to surgery, triggering medical necessity denials from commercial payers using TurningPoint or similar criteria tools

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Can I bill 29873 and 29874 together on the same knee for Medicare?

No. NCCI pairs 29873 with 29874 under a modifier indicator of '0', meaning no modifier can unlock separate payment. Medicare requires G0289 when chondroplasty or loose body removal accompanies 29873, and it must be performed in a separate compartment.

02Can I bill 29873 with G0289 on the same claim?

Yes, for Medicare, when the chondroplasty or loose body removal is performed in a different compartment than the lateral release. Document the compartment explicitly in the operative note — without that, the secondary service will deny.

03Does 29873 have a global period, and what does that cover?

Yes — 90-day global. It bundles the surgery date, the day-before pre-op visit, and all routine post-op care through day 90. Bill an unrelated E/M or procedure in that window with modifier 24 or 79 respectively.

04Can 29875 (limited synovectomy) be reported with 29873 on the same knee?

No. Per NCCI Chapter 4, 29875 cannot be reported with any other arthroscopic knee procedure on the ipsilateral knee. This applies regardless of payer and cannot be bypassed with a modifier.

05How do I report 29873 when performed bilaterally?

For professional claims, report one unit with modifier 50. For ASC facility claims, report on two separate lines using modifier LT on one and RT on the other, each with one unit of service.

06What ICD-10 codes typically support medical necessity for 29873?

Lateral patellar compression syndrome (M22.2x1/M22.2x2), patellar chondromalacia (M22.4x), and patellar tilt or tracking disorder codes are most commonly used. Report to the highest specificity including laterality — unspecified laterality codes are a common audit flag.

07Is a pre-authorization required for 29873?

Most commercial payers require prior authorization and apply clinical criteria (e.g., TurningPoint for Priority Health) that include documented failure of conservative treatment. Confirm auth requirements before scheduling — retro-authorization is rarely approved for arthroscopy.

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 laterality, the indication (patellar tilt, lateral compression syndrome, tracking dysfunction), intraoperative findings in each compartment, the specific release technique, and — critically — the compartment location of any secondary procedure such as chondroplasty. That compartment specificity is what supports separate billing of G0289 or a second arthroscopic code and prevents automatic bundling denials under NCCI.

See how Mira captures CPT 29873 documentation