Summary & Overview
CPT 27416: Osteochondral Autograft Transfer (Mosaicplasty)
CPT code 27416 represents osteochondral autograft transfer, also called mosaicplasty, a surgical method to repair focal articular cartilage defects by transplanting small bone-and-cartilage grafts from non–weight-bearing joint regions. The procedure is clinically important for restoring joint surface integrity and function, potentially delaying larger reconstructive surgeries. Nationally, it is relevant to orthopedic surgical practice patterns and reimbursement policies for cartilage restoration techniques.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical indications and the typical surgical setting, payer coverage considerations and common modifiers used in claim submissions, and related coding context. The publication also summarizes benchmark metrics and policy updates affecting coding and billing for cartilage repair procedures, and offers practical clarity on documentation elements that influence claim adjudication.
This summary is written for a national audience seeking concise guidance on the clinical purpose and billing context of CPT code 27416, situating the code within orthopedic service lines and typical sites of service.
Billing Code Overview
CPT code 27416 describes an autologous osteochondral grafting procedure commonly known as mosaicplasty. In this operation, the surgeon harvests small, circular bone-and-cartilage cores from a non–weight-bearing area of a joint that has intact cartilage cover and transplants those grafts to repair focal defects in articular cartilage.
Service type: Surgical — orthopedic cartilage restoration (osteochondral autograft transfer)
Typical site of service: Hospital outpatient department or ambulatory surgery center, performed on the knee using grafts from non–weight-bearing areas of the femoral condyles
Clinical & Coding Specifications
Clinical Context
A 28-year-old physically active patient presents with persistent focal full-thickness articular cartilage defect of the medial femoral condyle after a history of twisting knee injury and failed conservative care. Imaging with MRI demonstrates a 2.2 cm2 osteochondral lesion with preserved surrounding bone and no advanced osteoarthritis. The orthopedic surgeon schedules an arthrotomy or arthroscopic-assisted procedure for autologous osteochondral grafting (mosaicplasty) using small cylindrical osteochondral plugs harvested from a non–weight bearing area of the femoral condyle and transplanted into the defect.
Preoperative workflow includes clinical evaluation, informed consent, pre-op imaging review, and anesthesia assessment. Intraoperative steps include diagnostic arthroscopy, preparation of the recipient site, harvesting osteochondral plugs from non–weight bearing femoral condyle, placement and press-fit fixation of grafts to restore articular surface congruity, hemostasis, and wound closure. Postoperative workflow includes recovery room monitoring, pain control, immobilization or brace, graduated weight-bearing restrictions, and physical therapy for joint mobilization and strengthening. Typical site of service is an outpatient ambulatory surgery center or hospital outpatient department with regional or general anesthesia.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the surgeon's professional service separate from technical facility charges (rare for CPT 27416). |
50 | Bilateral procedure | Use when identical mosaicplasty is performed on both knees during the same operative session. |
51 | Multiple procedures | Use when 27416 is billed in conjunction with other distinct surgical procedures on the same date. |
52 | Reduced services | Use when the procedure is partially reduced or not completed as documented. |
53 | Discontinued procedure | Use when the procedure is started but terminated due to extenuating circumstances, documented in operative report. |
59 | Distinct procedural service | Use when another procedure on the same day is distinct and separately reportable from 27416. |
62 | Two surgeons | Use when two surgeons work together as primary surgeons performing distinct portions of the mosaicplasty. |
63 | Procedure performed on infants less than 4 kg | Use when applicable per patient age/weight criteria (rare for this code). |
78 | Unplanned return to the operating room | Use when patient returns to OR for a related procedure during the global period. |
79 | Unrelated procedure or service by the same physician during the postoperative period | Use when an unrelated procedure is performed during the global period. |
22 | Increased procedural services | Use when work required is substantially greater than usual, with supporting documentation. |
57 | Decision for surgery (not typically applicable) | Not commonly used for 27416; included in billing systems but rarely appended. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207X00000X | Orthopedic Surgery | Primary specialty performing osteochondral autograft transfer procedures. |
| 2080P0208X | Sports Medicine (Orthopaedic Surgery) | Subspecialty focused on joint preservation for athletes. |
| 208000000X | Hand Surgery / Extremity Reconstruction | Orthopedic subspecialists who may perform complex cartilage restoration in extremities. |
| 207L00000X | Orthopaedic Surgery of the Lower Extremity | Specialists focusing on knee and lower extremity cartilage procedures. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M17.0 | Primary osteoarthritis, bilateral knees | Chronic degenerative cartilage loss may prompt consideration of cartilage restoration in focal areas for younger patients, though generally a contraindication for mosaicplasty if diffuse. |
M17.11 | Unilateral primary osteoarthritis, right knee | Focal full-thickness defects in a younger patient with early osteoarthritic change may be managed with osteochondral grafting when appropriate. |
S83.241A | Tear of medial meniscus, current, right knee, initial encounter | Meniscal pathology often coexists and may be addressed in the same setting; focal cartilage defects can be associated with meniscal tears. |
M22.41 | Chondromalacia patellae, right knee | Focal chondral lesions of the patellofemoral joint can be an indication for osteochondral grafting when conservative care fails. |
S76.011A | Contusion of muscle, fascia and tendon of the right hip, initial encounter | Traumatic osteochondral lesions of the knee or adjacent joint surfaces after injury can lead to procedures like mosaicplasty. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
29881 | Arthroscopy, knee, surgical; synovectomy, limited | May be performed prior to or during cartilage restoration to address synovitis or evaluate the joint arthroscopically. |
27599 | Unlisted procedure, femur and knee | Sometimes used if a component of osteochondral grafting is atypical and no specific CPT exists for a particular adjunct procedure. |
27332 | Osteotomy, femoral, for correction of deformity | Performed in staged or concurrent cases when alignment correction is required for durable cartilage repair. |
20610 | Arthrocentesis, aspiration and/or injection; major joint or bursa | May be used pre- or postoperatively for diagnostic aspiration or therapeutic injections. |
29877 | Arthroscopy, knee, debridement/shaving of articular cartilage (chondroplasty) | May be performed arthroscopically as an adjunct to prepare the recipient site or treat other focal lesions. |