Summary & Overview
CPT 27447: Total Knee Arthroplasty (Complete Knee Replacement)
CPT code 27447 is a nationally recognized billing code for total knee arthroplasty, a procedure that replaces both the medial and lateral compartments of the knee joint, often addressing advanced joint disease and improving patient outcomes. This code is central to orthopedic surgery practices and is most commonly performed in inpatient hospital settings. The procedure is covered by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, reflecting its widespread clinical and financial significance.
This publication provides a comprehensive overview of 27447, including payer coverage, clinical context, and policy updates relevant to orthopedic surgery. Readers will gain insights into benchmarks for utilization, reimbursement trends, and the evolving landscape of medical necessity criteria. The analysis also highlights the importance of accurate coding and documentation for total knee arthroplasty, ensuring compliance with payer requirements and facilitating appropriate reimbursement. Key modifiers and associated diagnoses are discussed to clarify billing nuances and support clinical decision-making. The report is designed for healthcare professionals, administrators, and policy analysts seeking up-to-date information on this essential orthopedic procedure.
CPT Code Overview
CPT code 27447 represents a total knee arthroplasty, a surgical procedure involving the replacement of both the medial and lateral compartments of the knee condyle and plateau, with or without resurfacing of the patella. This procedure is classified under orthopedic surgery and is typically performed in an inpatient hospital setting (Place of Service 21). Total knee arthroplasty is a critical intervention for patients with severe knee joint disease, providing significant improvement in mobility and quality of life.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult patient with advanced degenerative joint disease, such as rheumatoid arthritis or malignant neoplasm affecting the knee, who has failed conservative management and requires surgical intervention. The patient is admitted to an inpatient hospital setting for a total knee arthroplasty, where both the medial and lateral compartments of the knee are replaced, with or without resurfacing of the patella. The procedure is performed by an orthopedic surgeon, often specializing in general orthopaedic surgery, orthopaedic trauma, or orthopaedic surgery of the spine. The clinical workflow includes preoperative assessment, imaging, surgical planning, intraoperative management, and postoperative care, including physical therapy and monitoring for complications.
Coding Specifications
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Modifiers:
RT: Indicates the procedure was performed on the right side.LT: Indicates the procedure was performed on the left side.50: Used when the procedure is performed bilaterally.22: Applied when the procedural services are increased due to complexity or additional work.
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207X00000X | Orthopaedic Surgery |
207XX0004X | Orthopaedic Surgery of the Spine |
207XS0117X | Orthopaedic Trauma |
These taxonomies represent providers specializing in general orthopaedic surgery, surgery of the spine, and trauma-related orthopaedic procedures.
Related Diagnoses
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C40.21: Malignant neoplasm of long bones of right lower limb- Relevant for patients requiring knee arthroplasty due to cancerous involvement of the right lower limb.
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C40.22: Malignant neoplasm of long bones of left lower limb- Indicates neoplastic disease in the left lower limb, potentially necessitating knee replacement.
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M05.061: Felty's syndrome, right knee- Felty's syndrome with involvement of the right knee may lead to joint destruction requiring arthroplasty.
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M05.062: Felty's syndrome, left knee- Felty's syndrome affecting the left knee can result in severe joint damage.
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M05.461: Rheumatoid myopathy with rheumatoid arthritis of right knee- Rheumatoid myopathy and arthritis in the right knee often progress to the need for surgical intervention.
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M05.462: Rheumatoid myopathy with rheumatoid arthritis of left knee- Similar to above, but affecting the left knee.
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M05.49: Rheumatoid myopathy with rheumatoid arthritis of multiple sites- Indicates widespread disease, which may include the knees and require arthroplasty.
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M05.561: Rheumatoid polyneuropathy with rheumatoid arthritis of right knee- Neuropathy and arthritis in the right knee can necessitate joint replacement.
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M05.562: Rheumatoid polyneuropathy with rheumatoid arthritis of left knee- Neuropathy and arthritis in the left knee may require surgical management.
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M05.761: Rheumatoid arthritis with rheumatoid factor of right knee without organ or systems involvement- Advanced rheumatoid arthritis in the right knee is a common indication for total knee arthroplasty.
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M05.762: Rheumatoid arthritis with rheumatoid factor of left knee without organ or systems involvement- Advanced rheumatoid arthritis in the left knee may lead to surgical intervention.
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M05.79: Rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement- Multiple joint involvement, including the knees, may require arthroplasty as part of comprehensive management.
Related CPT Codes
27448: Osteotomy, femur, shaft or supracondylar
27448 is related to 27447 as both are orthopedic surgical procedures involving the knee and femur. 27448 may be performed in conjunction with or as an alternative to 27447 in cases where realignment of the femur is necessary prior to or instead of total knee arthroplasty. These codes are not typically billed together unless clinically justified by the surgical workflow.
National Reimbursement Benchmarks
Medicare's national mean rate for CPT code 27447 is $1,175.78, which is significantly lower than the BUCA (Blue Cross Blue Shield, UnitedHealth Group, Cigna, Aetna) commercial average of $1,797.12. Among commercial payers, UnitedHealth Group has the highest mean rate at $2,482.97, while Aetna is the lowest at $1,426.60.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Aetna shows the tightest range ($694.33), indicating less variability in rates, while UnitedHealth Group exhibits the widest range ($1,366.33), reflecting greater variability. Cigna and Blue Cross Blue Shield also display substantial dispersion, with ranges of $1,298.00 and $881.93, respectively. Medicare's range is the narrowest at $88.00, suggesting highly standardized rates.
The table and chart below present the full breakdown of national benchmarks for CPT code 27447 by payer.
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