Summary & Overview
CPT 27415: Open Knee Allograft for Osteochondral Defect Repair
CPT code 27415 identifies an open surgical procedure accessing the knee joint to place an allograft for repair of an osteochondral defect. This code is used to bill for operative management of focal cartilage and subchondral bone lesions when a direct, open approach and donor graft placement are performed. Nationally, procedures for osteochondral repair are clinically important due to implications for joint function, potential to delay or prevent arthroplasty, and costs associated with operative care and graft materials.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context, typical sites of service (hospital operating rooms and ambulatory surgery centers), and common billing considerations associated with open knee allograft procedures. The publication summarizes standard coding use, common modifier patterns (listed separately), and areas where policy and coverage criteria commonly affect payment and utilization. Where input data is incomplete, the text notes that the specific items are not available.
This resource is intended for clinicians, billing professionals, and policy analysts seeking a concise national summary of CPT code 27415, including the procedure it represents and the payer landscape most relevant to its administration.
Billing Code Overview
CPT code 27415 describes an open surgical approach to the knee joint in which the provider places an allograft to repair an osteochondral defect. The procedure involves direct visualization and repair of damaged cartilage and underlying bone using donor graft tissue.
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Service type: Surgical — open knee allograft placement
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Typical site of service: Hospital operating room or ambulatory surgery center
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 28-year-old active male with a focal osteochondral defect of the medial femoral condyle after a twisting knee injury undergoes open autologous/allograft osteochondral transplantation. Preoperative workup includes MRI confirming a full-thickness chondral and subchondral defect approximately 2 cm2, history and physical, informed consent discussing graft type (here an allograft), and anesthesia evaluation. In the OR the surgeon performs an open arthrotomy to directly access the joint, prepares the defect, and implants a size-matched osteochondral allograft with fixation as needed. Postoperative plan includes immobilization, non-weight-bearing with crutches for several weeks, physical therapy focusing on range of motion progressing to strengthening, and routine follow-up visits with wound check and radiographic assessment of graft incorporation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | When work or time is substantially greater than usual for 27415 due to complexity or extensive debridement during graft placement. |
52 | Reduced services | When the procedure is partially reduced or not completed as planned (e.g., graft size smaller than intended). |
53 | Discontinued procedure | When the operation is terminated due to extenuating circumstances before completion of 27415. |
59 | Distinct procedural service | When another separate procedure is performed on the same day and should be reported as distinct from 27415. |
62 | Two surgeons | When two surgeons perform distinct portions of 27415, each with a documented portion of work. |
63 | Procedure performed on infants less than 4 kg | Applied if patient meets weight/age unusual circumstance per payer rules (rare for knee procedures). |
78 | Unplanned return to OR for related procedure during postoperative period | When a complication requires reoperation related to the original 27415 during the global period. |
79 | Unrelated procedure or service by the same physician during the postoperative period | When an unrelated procedure is performed during the global period following 27415. |
76 | Repeat procedure by same physician (note: not in provided list) | Data not available in the input. |
LT | Left side | When 27415 is performed on the left knee. |
RT | Right side | When 27415 is performed on the right knee. |
QX | Ordering/servicing clinical lab personnel (note: not typically applicable) | Data not available in the input. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207X00000X | Orthopaedic Surgery | Primary specialty performing open osteochondral allograft procedures of the knee. |
207L00000X | Sports Medicine (Orthopaedic) | Subspecialty focusing on cartilage restoration procedures in active patients. |
2080S0101X | Physical Medicine & Rehabilitation | Manages postoperative rehabilitation protocols after 27415. |
363L00000X | General Surgery | Data not typically applicable; included for completeness — may be present in institutions with cross-coverage (less common). |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M22.26 | Other articular cartilage disorder, left knee | Focal chondral lesion requiring osteochondral allograft for cartilage restoration. |
M22.25 | Other articular cartilage disorder, right knee | Same as above for right knee pathology. |
S83.241A | Bucket-handle tear of medial meniscus, right knee, initial encounter | Meniscal injury often coexists with osteochondral defects and may be addressed in the operative plan. |
M17.11 | Unilateral primary osteoarthritis, right knee | Advanced focal cartilage loss in younger patients may prompt restorative grafting in select cases. |
S89.011A | Contusion of knee, initial encounter | Acute trauma leading to osteochondral fragment or defect amenable to allograft repair. |
M94.261 | Chondromalacia patellae, left knee | Cartilage pathology that can be associated with focal defects considered in surgical planning. |
M24.561 | Recurrent dislocation, left knee | Instability-related chondral lesions may coexist and influence surgical approach. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
29881 | Arthroscopy, knee, surgical; with meniscal repair (medial OR lateral) | May be performed arthroscopically before or instead of open approaches; not usually concurrent with open 27415 but relevant in combined cartilage procedures. |
27427 | Ligamentous reconstruction, knee; extra-articular (e.g., LCL) | May be performed in the same episode if instability coexists and requires separate reconstruction. |
27370 | Arthrotomy, knee, with synovectomy (separate procedure) | May be performed during the same operation to address synovitis prior to graft placement. |
20930 | Allograft, osteochondral, for knee (includes procurement, processing) | Billed when an osteochondral allograft is implanted; directly related to material supply for 27415. |
20610 | Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., knee) | May be used preoperatively or postoperatively for diagnostic aspiration or corticosteroid injection in the care continuum. |
73564 | Radiologic exam, knee, unilateral, 3 views | Commonly obtained preoperatively and postoperatively to document joint status and hardware/graft position. |