Summary & Overview

CPT 27403: Knee Arthrotomy with Meniscus Repair

CPT code 27403 denotes an arthrotomy of the knee with meniscus repair, an open surgical procedure used to treat meniscal tears and alleviate knee pain. This code is commonly used in orthopedic and sports-medicine surgical billing and affects facility and professional reimbursement for knee joint repair services nationwide. It is clinically significant because meniscal repair decisions influence patient outcomes, postoperative care pathways, and overall episode costs.

Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the procedure, expected sites of service, and the typical service classification. The publication summarizes national benchmarks and payer coverage patterns where available, highlights relevant billing considerations, and summarizes recent policy or coding clarifications that affect coding and claim adjudication for knee arthrotomy with meniscus repair.

This analysis is intended for billing managers, orthopedic providers, revenue cycle staff, and policy analysts seeking a concise reference on procedure classification, payer landscape, and operational implications tied to CPT code 27403.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare27403CPTknee surgerymeniscus repairarthrotomyorthopedicssurgical billingambulatory surgery

Billing Code Overview

CPT code 27403 describes an arthrotomy of the knee joint with meniscus repair. The procedure involves surgically opening the knee joint (arthrotomy) to access and repair a torn meniscus with the goal of relieving pain and restoring joint function.

Service type: Surgical orthopedic procedure — open knee surgery with meniscal repair
Typical site of service: Hospital operating room or ambulatory surgery center

Clinical & Coding Specifications

Clinical Context

A 28-year-old recreational athlete presents with several weeks of persistent lateral knee pain, intermittent mechanical catching, and swelling after a twisting injury sustained during soccer. Physical exam demonstrates a positive McMurray test and joint line tenderness. MRI confirms a complex tear of the lateral meniscus with associated joint effusion. The orthopedic surgeon schedules an open arthrotomy with meniscal repair to address a tear not amenable to arthroscopic repair, manage associated intra-articular pathology, and relieve pain. The procedure is performed in an ambulatory surgery center under general anesthesia. Preoperative workflow includes history and physical, consent, imaging review, anesthetic assessment, and perioperative antibiotic prophylaxis. Intraoperatively the surgeon performs a knee arthrotomy, inspects the joint, performs meniscal repair with sutures or fixation devices, achieves hemostasis, and closes the wound. Postoperative workflow includes recovery room monitoring, pain control, wound care instructions, limited weight bearing as indicated, referral to physical therapy, and follow-up visits for suture removal and monitoring of healing and function.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, or complexity substantially exceed typical for `27403`.
`23`	Unusual anesthesia	Use when general anesthesia is medically necessary for a procedure usually performed with local/monitored anesthesia care.
`24`	Unrelated evaluation and management service during postoperative period	Use if unrelated E/M care is provided during the global period (note: `24` not listed in input — Data not available in the input).
`50`	Bilateral procedure	Use when bilateral knee arthrotomies/repairs are performed during the same operative session.
`51`	Multiple procedures	Use when `27403` is billed along with additional distinct procedures performed at the same session.
`52`	Reduced services	Use when `27403` is partially reduced or not completed as originally planned.
`53`	Discontinued procedure	Use when `27403` is started but discontinued due to extenuating circumstances prior to completion.
`58`	Staged or related procedure or service by same physician during postoperative period	Use when `27403` is planned as a staged or more extensive procedure following a prior operation.
`59`	Distinct procedural service	Use to indicate a separate, distinct service from other procedures performed the same day when not normally bundled.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of `27403`.
`76`	Repeat procedure by same physician (not in provided list) — Data not available in the input

Taxonomy Code	Specialty	Notes
Data not available in the input	Orthopaedic Surgery	Surgeons who most commonly perform open knee arthrotomy and meniscus repair.
Data not available in the input	Sports Medicine (Orthopaedics)	Specialists focusing on athletic knee injuries and meniscal repair.
Data not available in the input	Hospitalist/Anesthesiology	Perioperative anesthesia and inpatient perioperative care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S83.241A`	Complex tear of lateral meniscus, current injury, right knee, initial encounter	Lateral meniscal tear causing mechanical symptoms and pain; common indication for meniscal repair via arthrotomy when not amenable to arthroscopic repair.
`S83.242A`	Complex tear of lateral meniscus, current injury, left knee, initial encounter	Same as above for the left knee.
`M23.21`	Derangement of lateral meniscus due to old tear or injury, right knee	Chronic meniscal derangement presenting with pain and locking that may require open repair.
`M23.22`	Derangement of lateral meniscus due to old tear or injury, left knee	Same as above for the left knee.
`M17.11`	Unilateral primary osteoarthritis, right knee	Osteoarthritic changes may coexist and influence repair decisions; sometimes addressed concurrently.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27405`	Repair, primary, torn patellar tendon;	Not directly bundled — example of another knee repair code; may be performed for concurrent extensor mechanism injury in the same operative setting.
`29881`	Arthroscopy, knee, surgical; meniscal repair (including meniscal transplantation when performed)	Commonly used when meniscal repair is performed arthroscopically rather than via open arthrotomy; an alternative approach to `27403`.
`27332`	Debridement, knee, open;	May be performed in conjunction with open arthrotomy to remove loose bodies or perform synovectomy prior to meniscal repair.
`20670`	Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee)	May be performed pre- or postoperatively for diagnostic or therapeutic joint aspiration.
`99223`	Initial hospital care, typically 70 minutes or more	Example hospital E/M code for inpatient preoperative or postoperative care when patient status requires inpatient services.