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SpecialistBase2026 Compliant

CPT 27447

2026 Billing Guide

Total Knee Arthroplasty

Reimbursement

$1125.58

Threshold

N/A

2026 Status

Active

What is CPT Code 27447?

CPT 27447 is defined as: Total Knee Arthroplasty (TKA) is a major surgical procedure involving the replacement of the damaged or diseased surfaces of the knee joint with prosthetic components. The procedure includes the resurfacing of the medial and lateral femoral condyles and the tibial plateau, with or without resurfacing of the patella. It is the definitive treatment for end-stage osteoarthritis or severe joint destruction.

This code is primarily used for Specialist services. It falls under the category of Surgery / Musculoskeletal System and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.

2026 RVU Components

Relative Value Units (Non-Facility)

Standard Formula Applied

Work RVU

18.5

Physician Effort

PE (Non-Fac)

12.5

Practice Expense

Malpractice

Risk Factor

Total RVU

33.7

Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor

2026 CMS Policy Intelligence

efficiency adjustment

Subject to -2.5% Efficiency Adjustment. CMS has reduced the Work RVU component based on time studies showing that surgical refinements and perioperative 'ERAS' (Enhanced Recovery After Surgery) protocols have reduced the total physician time involved.

pe facility redistribution

As a facility-based service, TKA is impacted by the 2026 shift in indirect cost allocation, which reduces facility-based PE relative to office-based services.

conversion factor

Utilizes the 2026 Non-QP rate of $33.40.

Administrative Framework

Global Period

090 (90 Days)

Place of Service

21 (Inpatient Hospital)22 (Outpatient Hospital - ASC)

NCCI Exclusions

Do not bill with:2061027438274462988176000

Key Modifiers

22Increased procedural services. Used for complex revisions or cases with significant deformity requiring extra operative time.
50Bilateral procedure. Append if both knees are replaced during the same operative session. Reimbursement is typically 150% of the allowable.

Operational Requirements

global bundle

The 90-day global period includes the pre-operative visit (day before), the surgery, and all routine post-operative care for 90 days. Complications that do not require a return to the OR are also included.

inpatient vs outpatient

TKA was removed from the Medicare Inpatient-Only (IPO) list; it can be performed in an ASC or Outpatient Hospital setting (POS 22) if the patient meets safety criteria.

documentation operative note

Must detail the approach (e.g., medial parapatellar), bone cuts, implant types and sizes, and ligament balancing techniques.

assistant surgeon necessity

Medicare Advantage and commercial payers may require documentation of why an assistant surgeon (Modifier 80) was required for a routine TKA.

Compliance Checklist

Detailed time tracking (cumulative for the month).
Specific clinical decision-making documentation.
Electronic care plan availability and access log.

Audit Defense

No specific audit defense elements defined.

2026 Update

Work RVU reduced by 2.5% efficiency adjustment. National payment is ~$1162.68 (Facility).

Common Clinical Scenarios

No clinical examples provided.

Target Specialties & Utilization

Orthopedic Surgery

Typical Clinical Indications (ICD-10)

M17.11 (Unilateral primary osteoarthritis, right knee)M17.12 (Unilateral primary osteoarthritis, left knee)M17.0 (Bilateral primary osteoarthritis of knee)

Frequently Asked Questions

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