Summary & Overview
CPT 27425: Lateral Retinacular Release for Patellar Subluxation
CPT code 27425 denotes lateral retinacular release, a surgical soft-tissue procedure that divides the lateral retinaculum to realign and stabilize the patella, most often used for patellar subluxation or partial dislocation. Nationally, this code represents a targeted orthopedic intervention with implications for surgical practice patterns, outpatient procedural volumes, and payer coverage policy for knee-stabilizing surgeries. Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. This publication provides readers with clinical context for when 27425 is used, common sites of service, and the policy and billing considerations that affect reimbursement and utilization. Readers will find benchmarks and coverage themes, summary guidance on documentation expectations and common modifier usage, and an outline of clinical indications and procedural scope tied to the code. The report is intended for coding professionals, surgical practices, billing teams, and policy analysts seeking a concise national view of how CPT code 27425 is applied and reimbursed across major public and commercial payers.
Billing Code Overview
CPT code 27425 describes a surgical procedure in which the provider incises or divides the tight lateral retinaculum, a fibrous band on the outer side of the knee that helps stabilize the patella. The procedure is most commonly performed to treat patellar subluxation or partial dislocation of the kneecap.
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Service type: Surgical procedure, soft tissue release of the knee surrounding the patella
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Typical site of service: Hospital outpatient department or ambulatory surgery center, occasionally performed in inpatient surgical settings depending on clinical circumstances
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Clinical & Coding Specifications
Clinical Context
A 19-year-old athlete presents with recurrent lateral patellar instability and painful partial dislocations of the right kneecap after nonoperative management (physical therapy, bracing) failed. Examination demonstrates positive lateral patellar glide and tenderness along the lateral retinacular structures. Imaging (radiographs and MRI) confirms lateral maltracking without high-grade chondral loss. The orthopedic surgeon schedules a surgical lateral retinacular release under regional or general anesthesia in an outpatient ambulatory surgery center.
Preoperative workflow includes history and physical, informed consent documenting indication (patellar subluxation/partial dislocation), review of imaging, preoperative anesthesia assessment, and marking of the operative site. Intraoperative steps typically include diagnostic arthroscopy if indicated, a controlled incision and division of the tight lateral retinaculum to relieve lateral tethering of the patella, hemostasis, and closure. Postoperative workflow includes recovery room monitoring, discharge instructions with weight‑bearing and range‑of‑motion guidance, follow-up for wound check and rehabilitation focusing on quadriceps strengthening and patellar stabilization. Typical site of service is an outpatient ambulatory surgery center or hospital outpatient department. Service type: surgical orthopedic procedure of the knee (soft tissue release).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
RT | Right side |