Arthroscopy · Knee

Arthroscopic knee surgery for drilling and internal fixation of an osteochondritis dissecans (OCD) lesion — intact cartilage is drilled to stimulate healing and secured with hardware.

Verified May 8, 2026 · 6 sources ↓

Medicare: $710.44
Total RVUs: 21.27
Global, days: 90
Region: Knee

Drawn from CMSAAPCElitelearningAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm the OCD lesion was intact (cartilage not detached) at the time of surgery — this distinguishes 29887 from loose-body removal codes
Name both components explicitly in the operative note: drilling of the subchondral bone AND internal fixation with hardware (type, size, and number of screws or pins)
Document compartment-by-compartment findings (medial, lateral, patellofemoral) to support or refute add-on billing for G0289 or other concurrent procedures
Record laterality (left vs. right) consistently across the operative note, scheduling system, and claim — required for LT/RT modifier assignment
Include pre-op imaging (MRI) confirming intact OCD lesion with size, location, and stability assessment
Note patient age and skeletal maturity status — relevant to medical necessity justification for this repair-focused approach over observation

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 29887 covers arthroscopic treatment of an intact osteochondritis dissecans lesion of the knee. The surgeon drills through the intact but compromised cartilage and subchondral bone to stimulate vascular ingrowth and biological healing, then places internal fixation — typically screws or pins — to stabilize the fragment against the underlying bone. The procedure is distinct from 29885 (drilling without fixation) and 29886 (fixation without drilling); 29887 requires both components to be documented.

This code sits at the top of the OCD arthroscopy ladder (29885–29887) and carries a 90-day global period under CMS. All routine post-op visits, dressings, and hardware checks through day 90 are included. Staged or unrelated procedures within that window need modifier 78 or 79, respectively. OCD of the knee is most common in adolescents and young adults; ICD-10 M93.261–M93.269 covers the laterality variants and should match the operative side on the claim.

NCCI edits prohibit bundling 29874 or 29877 with 29887 on the same knee. If chondroplasty is performed in a genuinely separate compartment, G0289 may be separately reportable for Medicare — but not 29877. Document compartment-by-compartment findings explicitly in the operative note to support any add-on billing.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.91
Practice expense RVU	9.25
Malpractice RVU	2.11
Total RVU	21.27
Medicare national rate	$710.44
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	$710.44
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,298.84

Common denial reasons

The recurring reasons claims for CPT 29887 get rejected.

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

Laterality mismatch between the operative report and the claim — missing or incorrect LT/RT modifier triggers automatic denial
Insufficient documentation of both drilling AND fixation — auditors deny 29887 and downcode to 29885 or 29886 when only one component is described
29877 billed same-day on the ipsilateral knee — NCCI bundles chondroplasty into 29887; use G0289 with compartment documentation for Medicare if applicable
Medical necessity denial when pre-op MRI is absent or does not confirm an intact (non-displaced) OCD lesion requiring fixation
Global period violation — routine post-op follow-up billed without modifier 24 within the 90-day global window

Frequently asked questions

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

01What separates 29887 from 29885 and 29886?

29885 is drilling alone with no fixation. 29886 is fixation alone with no drilling. 29887 requires both — document each component by name in the operative report or auditors will downcode.

02Can I bill 29877 (chondroplasty) with 29887 on the same knee?

No. NCCI bundles 29877 into all knee arthroscopy codes 29866–29889. For Medicare, if chondroplasty is performed in a different compartment from the OCD work, G0289 may be separately reportable — but only with explicit compartment documentation.

03What ICD-10 codes support 29887?

M93.261–M93.269 (osteochondritis dissecans, knee, with laterality variants) are the primary diagnoses. M93.261 = right knee, M93.262 = left knee, M93.269 = unspecified. Match laterality to the operative side.

04Does 29887 carry a global period, and what does that mean for post-op visits?

Yes — 90-day global. Routine post-op visits, hardware checks, and dressing changes through day 90 are included in the surgical fee. Append modifier 24 for E/M visits unrelated to the surgery, or modifier 78 for an unplanned return to the OR for a related complication.

05When is modifier 22 appropriate for 29887?

Use modifier 22 when the procedure is substantially more work than typical — for example, an unusually large or complex OCD lesion requiring multiple fixation points across compartments. The operative note must describe the increased complexity, time, and effort explicitly; a vague reference is insufficient to support the modifier.

06Can 29887 be billed bilaterally?

Bilateral OCD requiring fixation in both knees at one session is rare but not impossible. Bill with modifier 50 or with separate line items appended LT and RT. Expect documentation scrutiny — both knees need pre-op imaging and distinct intraoperative findings.

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 OCD lesion status (intact vs. displaced), drilling technique, fixation hardware type and count, and compartment-specific findings from the surgeon's dictation. That detail prevents downcoding to 29885 or 29886 and supports same-day G0289 billing when chondroplasty is documented in a separate compartment.

See how Mira captures CPT 29887 documentation