Summary & Overview
CPT 27418: Tibial Tubercle Osteotomy for Patellar Stabilization
CPT code 27418 identifies a tibial tubercle osteotomy in which the tibial tubercle is advanced and elevated to change patellar alignment and reduce patellofemoral joint load. This orthopedic surgical code is used for patients with symptomatic patellar maltracking or instability causing anterior knee pain in the absence of degenerative arthritis. Nationally, the procedure matters because it affects surgical utilization, post-operative care pathways, and cost profiles across inpatient and outpatient surgical settings.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical context for the procedure, typical sites of service, and coverage landscape implications for major national payers. The publication summarizes common billing practices, typical modifiers used with this code, and considerations for reimbursement and site-of-service selection. It also outlines the clinical indications reflected in the code description and what stakeholders should track in policy updates and utilization benchmarks.
Data not available in the input: associated taxonomies, specific ICD-10 diagnosis mappings, related codes, and payer-specific policy language.
Billing Code Overview
CPT code 27418 describes a surgical procedure to reposition the tibial tubercle by moving it upward and forward (anteriorization and proximalization) to alter patellar tracking and reduce load on the patellofemoral joint. The intent of the procedure is to relieve knee cap (patellar) pain that occurs without arthritis by changing the insertion point of the patellar tendon on the tibia.
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Service type: Orthopedic surgical procedure to correct patellar maltracking and reduce patellofemoral joint load
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Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 22-year-old recreational runner presents with persistent anterior knee pain centered around the patella that has failed conservative care including physical therapy, activity modification, NSAIDs, and bracing for 6–12 months. Examination demonstrates lateral maltracking of the patella with tenderness at the tibial tubercle and a high tibial tubercle–trochlear groove (TT-TG) distance on imaging. The orthopedic sports medicine surgeon plans an anteromedialization of the tibial tubercle to offload the patellofemoral joint and improve patellar tracking.
The clinical workflow includes preoperative evaluation with history, physical exam, standing and axial knee radiographs and MRI to assess cartilage, measurement of the TT-TG distance, surgical consent, scheduling for inpatient or ambulatory surgical center (ASC) based on patient health, performance of the 27418 tibial tubercle osteotomy with anteromedialization under general or regional anesthesia, intraoperative fixation of the tubercle with screws, postoperative pain control and thromboprophylaxis as indicated, and follow-up visits for wound check and progressive rehabilitation focusing on quadriceps control and gradual return to activity. Typical perioperative documentation includes operative report, anesthesia record, implant log, and detailed postoperative instructions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Distinct procedural service |