Summary & Overview
CPT 27405: Primary Repair of Knee Collateral Ligament and Capsule
CPT code 27405 identifies primary surgical repair of a torn collateral ligament and/or capsule of the knee, performed immediately after injury. This code is relevant nationwide for orthopedic surgeons, facility billing teams, and payers because it denotes an acute, operative intervention addressing medial or lateral knee stability. Coverage, payment policies, and utilization patterns for this code affect surgical care pathways, authorization workflows, and facility resource planning across commercial and public payers.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for acute collateral ligament repair, benchmarks for coding and billing practice, and summaries of payer coverage considerations and common billing modifiers. The publication highlights where policy updates and documentation best practices intersect with coding for immediate primary repair versus delayed reconstruction.
This analysis provides clinicians and billing professionals a concise reference on what CPT code 27405 represents, typical sites of service, and the payer landscape that commonly adjudicates claims for acute knee ligament repair. Data not available in the input is noted where applicable in detailed sections.
Billing Code Overview
CPT code 27405 describes the primary repair of a torn collateral ligament and/or capsule of the knee. The procedure involves immediate surgical repair of the medial or lateral collateral ligament and/or the joint capsule following an acute knee injury.
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Service type: Surgical repair of knee collateral ligaments (orthopedic surgical procedure)
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Typical site of service: Ambulatory surgical center or hospital operating room
Clinical & Coding Specifications
Clinical Context
A 28-year-old male presents to the emergency department after a contact sports injury to the knee with immediate lateral instability and a visible joint line swelling. Imaging (plain radiographs and MRI) demonstrates an acute tear of the medial collateral ligament (MCL) near its femoral attachment and associated capsular disruption. The patient is taken to the operating room within 48 hours for primary repair of the torn collateral ligament and capsule under general anesthesia. The clinical workflow includes preoperative evaluation, consent, intraoperative ligament and capsular repair via an open approach, hemostasis, irrigation, layered closure, application of dressing and knee immobilizer, and postoperative instructions with referral to physical therapy for early protected range-of-motion and strengthening.
Typical site of service: hospital operating room or ambulatory surgery center.
Service type: surgical, open primary repair of a torn collateral ligament and/or knee capsule using suture repair techniques and possible anchor fixation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the repair required substantially greater effort, time, or complexity than typical. |