Arthroscopy · Knee

Arthroscopic-assisted anterior cruciate ligament repair or augmentation of the knee, performed endoscopically.

Verified May 8, 2026 · 7 sources ↓

Medicare: $889.47
Total RVUs: 26.63
Global, days: 90
Region: Knee

Drawn from CMSAAOSAoassnAAPC

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify the ligament repaired or augmented (primary ACL repair vs. augmentation) and the surgical technique used.
Document the graft type and harvest site (autograft — patellar tendon, hamstring, quadriceps; allograft) with the specific donor location if contralateral.
Confirm arthroscopic approach and portal placement in the operative note — don't use generic language like 'standard arthroscopic technique'.
Record laterality (right vs. left knee) explicitly in both the operative report and the billing record.
If modifier 22 is appended, document the specific factors that increased operative complexity — prior surgery, altered anatomy, obesity, or prolonged operative time with explanation.
For same-day E/M billed with modifier 25, document that the evaluation addressed a condition distinct from the decision to perform the ACL procedure.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 51 Multiple procedures 57 Decision for surgery 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 29888 covers arthroscopic-assisted ACL repair or augmentation — a procedure where the surgeon uses endoscopic visualization to repair a torn anterior cruciate ligament or reinforce a compromised one, typically with a graft. The arthroscopic approach distinguishes this from open ACL reconstruction; the camera guides the entire repair through small portals rather than an open incision.

The 90-day global period means the surgical fee bundles the pre-op visit (day before or day of), the procedure itself, and all routine post-op care through day 90. Any E/M visit unrelated to ACL recovery during that window requires modifier 24. If you're billing a same-day E/M for a separate problem on the day of surgery, append modifier 25 to the evaluation code.

When graft harvest is performed from the contralateral knee, be careful: that harvest code may trigger an NCCI PTP edit. Modifier 59 (or XS) can override the edit only when the graft truly comes from a separate anatomic site — document it explicitly. Fluoroscopy used during the arthroscopic procedure is integral and not separately reportable.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	13.94
Practice expense RVU	9.95
Malpractice RVU	2.74
Total RVU	26.63
Medicare national rate	$889.47
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	$889.47
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,817.25

Common denial reasons

The recurring reasons claims for CPT 29888 get rejected.

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

Missing or ambiguous laterality — payers deny without clear RT or LT designation in the claim and operative note.
NCCI PTP bundling conflict when contralateral graft harvest code is billed without modifier 59 or XS and supporting documentation of separate anatomic site.
Global period violation — routine post-op E/M visits billed without modifier 24 during the 90-day global are denied as already included in the surgical payment.
Modifier 22 appended without operative documentation quantifying substantially increased work — auditors reject unsupported complexity claims.
Fluoroscopy billed separately alongside 29888 — it is integral to the arthroscopic procedure and not reimbursable as a distinct service.

Frequently asked questions

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

01What is the global period for CPT 29888?

90 days. That covers the day-before or day-of pre-op visit, the procedure, and all routine post-op care through day 90. Bill modifier 24 on any unrelated E/M during that window.

02Can I bill for graft harvest separately when performing 29888?

It depends on the harvest site. Graft from the ipsilateral knee is generally bundled. If the graft is harvested from the contralateral knee, that is a separate anatomic site — append modifier 59 or XS and document the distinct site clearly in the operative note. Expect payer scrutiny; the NCCI PTP edit is active on common harvest code pairings.

03Should I bill modifier 50 if I perform ACL repair on both knees the same day?

For Medicare facility claims, report 29888 with modifier 50 on a single claim line. For ASC claims, report two lines — one with modifier LT and one with RT. Bilateral ACL repair on the same day is rare; document the clinical necessity thoroughly.

04Can I separately bill fluoroscopy used during the arthroscopic ACL repair?

No. Per NCCI policy, fluoroscopy performed during an arthroscopic procedure is integral to the procedure and is not separately reportable. Billing it separately will be denied.

05When does modifier 57 apply to an E/M on the day of or day before 29888?

Use modifier 57 on the E/M code when the decision to perform the ACL repair was made at that visit and the procedure carries a 90-day global. This allows the E/M to be paid outside the global. Do not use modifier 57 on the surgical code itself — it belongs on the E/M.

06What modifier applies if the patient needs an unplanned return to the OR for ACL graft failure or complication during the global period?

Use modifier 78 for an unplanned return to the OR for a procedure related to the original ACL surgery during the 90-day global. Use modifier 79 only if the return procedure is entirely unrelated to the ACL repair.

07Is an assistant surgeon billable for 29888?

Potentially. Append modifier 80 for a physician assistant surgeon or modifier AS for a PA/NP/CRNA first assistant. Medicare coverage for surgical assistants on arthroscopic procedures varies by payer and local coverage determination — verify before billing.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures ACL laterality, graft source and harvest site, portal placement, and repair versus augmentation status directly from the surgeon's dictation. It flags when graft harvest from the contralateral knee is mentioned — prompting the coder to apply modifier 59 or XS with site-specific documentation — and confirms that fluoroscopy use is noted as integral rather than billed separately, preventing a common audit flag.

See how Mira captures CPT 29888 documentation