CPT 27407: Knee Cruciate Ligament and Capsule Repair - OpenPayer

Summary & Overview

CPT 27407: Knee Cruciate Ligament and Capsule Repair

CPT code 27407 denotes surgical repair of a primary tear of the cruciate ligament or capsule of the knee. This code captures procedures intended to relieve pain and restore gait by directly repairing torn cruciate structures and adjacent capsule tissue. It is commonly used for acute primary tears where repair (rather than reconstruction) is performed.

This publication addresses national considerations for CPT code 27407 across major payers, including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context, typical sites of service, and the kinds of procedural care represented by the code. The analysis highlights common billing and coverage themes that affect reimbursement and authorization workflows for ligament repair procedures.

Readers will learn practical benchmarks and policy-relevant points: the clinical indications that align with this repair procedure, typical settings where the service is delivered (hospital OR and ambulatory surgical centers), and the payer landscape affecting prior authorization and claims adjudication. Data not available in the input is noted where applicable, and the report focuses on nationally relevant guidance rather than state-specific rules.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 27407knee surgeryligament repairorthopedic surgeryambulatory surgical centerhospital inpatientsurgical CPTknee capsule repair

Billing Code Overview

CPT code 27407 describes a surgical procedure to repair a primary tear of the cruciate ligament or capsule of the knee. The procedure is performed to alleviate pain and restore gait by reestablishing knee stability through direct repair of the torn ligament or joint capsule.

Service type: Knee ligament repair surgery

Typical site of service: Hospital operating room or ambulatory surgical center

Clinical & Coding Specifications

Clinical Context

A 32-year-old recreational soccer player presents with acute right knee pain, swelling, and instability after a pivoting injury. Clinical exam demonstrates a positive anterior drawer and Lachman test. MRI confirms a primary tear of the anterior cruciate ligament (ACL) with associated capsular irritation. The orthopedic surgeon schedules operative repair of the torn cruciate ligament to restore knee stability, alleviate pain, and allow return to function. Preoperative workflow includes history and physical, imaging review, informed consent, anesthesia evaluation, and pre-op labs. Intraoperative workflow for 27407 includes general or regional anesthesia, arthrotomy or arthroscopic-assisted exposure as indicated, identification of the ligament tear, primary ligament or capsular repair using suture anchors or direct suture repair, hemostasis, and wound closure. Postoperative workflow includes PACU recovery, pain control, early range-of-motion protocol, physical therapy referral, and follow-up visits for wound check and rehabilitation progression.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the repair requires substantially greater effort or time than usual (document increased work).

CPT 27420: Patellar Tendon Transfer with Bone Block

cpt-27396-thigh-tendon-transfer

CPT 27396: Thigh Muscle Tendon Transfer

cpt-27454-femoral-osteotomy-intramedullary-rod-fixation

CPT 27454: Multiple Femoral Osteotomies with Intramedullary Rod Fixation

cpt-27470-femur-nonunion-malunion-repair-no-graft

CPT 27470: Repair of Femur Nonunion or Malunion Without Graft

cpt-27450-femoral-osteotomy-with-fixation

CPT 27450: Femoral Osteotomy with Fixation

27486

CPT 27486: Revision of Total Knee Arthroplasty, With or Without Allograft

cpt-27390-open-tenotomy-hamstring-single-tendon

CPT 27390: Open Tenotomy of Single Hamstring Tendon

27442

CPT 27442: Arthroplasty of Femoral Condyles or Tibial Plateau

27487

CPT 27487: Revision of Total Knee Arthroplasty, With or Without Allograft

cpt-27428-knee-intra-articular-ligament-reconstruction

CPT 27428: Knee Intra-articular Ligament Reconstruction

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Taxonomy Code	Specialty	Notes
`207XS0102X`	Orthopaedic Surgery	Common primary specialty performing cruciate ligament repairs.
`207YP0106X`	Sports Medicine (Orthopaedic)	Common for athletes and active patients; often performs ligament repairs.
`282N00000X`	Physical Medicine & Rehabilitation	Common for postoperative rehabilitation coordination and nonoperative management.
`2081S0122X`	General Surgery	Occasional involvement when combined procedures or complex soft-tissue reconstruction is required.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S83.511A`	Sprain of anterior cruciate ligament of right knee, initial encounter	Directly describes an acute primary ACL tear treated with repair.
`S83.512A`	Sprain of anterior cruciate ligament of left knee, initial encounter	Left-knee equivalent when `27407` is performed on left side.
`M23.511`	Chronic instability of right knee	Indicates chronic cruciate deficiency that may require repair or reconstruction.
`S83.521A`	Tear of medial meniscus, current injury, right knee, initial encounter	Common concomitant intra-articular injury identified and addressed during ACL repair.
`M24.211`	Spontaneous disruption of ACL, right knee	Describes nontraumatic or degenerative ACL disruption requiring surgical repair.
`M17.11`	Unilateral primary osteoarthritis, right knee	Degenerative changes that may complicate repair decisions or be addressed concurrently.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`29888`	Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction	Common arthroscopic alternative or adjunct; may be performed instead of or in conjunction with open `27407` repair.
`27500`	Repair, primary, torn patellar tendon, with or without implant	May be performed for concomitant extensor mechanism injuries in the same operative session.
`27370`	Repair, primary, torn collateral ligament, knee	Performed for associated medial or lateral collateral ligament tears during the same operative episode.
`29870`	Arthroscopy, knee, diagnostic, with or without synovial biopsy	May be performed pre-repair to evaluate intra-articular pathology and guide repair approach.
`20670`	Removal of deeply implanted foreign body, requiring incision and deep dissection	Performed if hardware removal or deep foreign body extraction is required during the procedure.

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