Summary & Overview
CPT 27422: Patellar Tendon Transfer with Extensor Mechanism Realignment
CPT code 27422 denotes a surgical reconstruction procedure that transfers the patellar tendon insertion as a bone block combined with extensor mechanism realignment to treat a dislocating patella. Nationally, this code captures complex orthopedic procedures aimed at correcting recurrent patellar instability, a contributor to chronic knee pain, functional impairment, and potential long-term joint damage. Because the procedure involves bony work and soft-tissue realignment, it has implications for operative setting, length of stay decisions, and reimbursement classification across payers.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield plans, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical intent and service context of CPT code 27422, an overview of common payer coverage considerations and modifiers used with the code, and a summary of how this procedure is typically categorized for site-of-service decisions. The publication also outlines benchmarks and policy updates relevant to hospitals and ambulatory surgical centers that manage patellar stabilization surgeries. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 27422 describes a surgical procedure in which the provider transfers the entire patellar tendon insertion as a bone block and performs extensor mechanism realignment, including muscle transfer or release, to treat a dislocating patella. This operation addresses recurrent or severe patellar instability by improving alignment and stabilization of the patella within the knee joint.
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Service type: Orthopedic reconstructive surgery of the knee, specifically patellar tendon transfer with extensor mechanism realignment
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Typical site of service: Hospital outpatient department or ambulatory surgical center; may also be performed in an inpatient setting depending on clinical complexity and comorbidities
Clinical & Coding Specifications
Clinical Context
A typical patient is a 16–30-year-old athlete presenting with recurrent lateral patellar dislocations and activity-limiting anterior knee pain despite conservative care (physical therapy, bracing, activity modification). Exam shows patellar instability with a positive apprehension sign and imaging demonstrates maltracking and a lateralized tibial tubercle or attenuated medial restraints. The surgical workflow begins with preoperative assessment, informed consent, and anesthesia evaluation. In the operating room under general or regional anesthesia, the orthopedic surgeon performs exposure of the patellar tendon insertion, elevates a bone block from the tibial tubercle, mobilizes and transfers the patellar tendon insertion to a more medial position, and secures the bone block with screws or fixation to realign the extensor mechanism. Concomitant procedures may include medial patellofemoral ligament reconstruction, lateral release, or femoral/tibial osteotomies if indicated. Postoperative care includes pain control, immobilization or brace, weight-bearing restrictions, and a staged rehabilitation program focusing on quadriceps control and gradual return to sport. Typical site of service is an inpatient or outpatient hospital operating room or ambulatory surgery center depending on patient comorbidities and facility capabilities.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the procedure required substantially greater work than typical due to severe deformity, extensive scarring, or unexpected complexity. |