Summary & Overview
CPT 27428: Knee Intra-articular Ligament Reconstruction
CPT code 27428 represents surgical reconstruction of intra–articular ligaments of the knee, including possible graft use to reinforce the repair. This procedure is a common orthopedic intervention for significant internal knee ligament injuries and carries implications for surgical resources, post-operative rehabilitation, and payer coverage policies nationwide. It matters nationally because it is associated with operative management of functionally limiting knee instability and impacts utilization and cost in musculoskeletal care.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, site-of-service considerations, and the types of benchmarks and policy elements typically examined for this code, such as utilization patterns across hospital and ambulatory surgery settings, authorization and coverage trends, and quality and outcome measures linked to ligament reconstruction.
The publication provides: clinical description and service-line placement for 27428; typical sites of service and procedural context; a summary of payer coverage considerations and common modifier usage patterns (where available); and areas where policy updates or coding clarifications commonly arise. Data not available in the input will be noted as such in relevant sections.
Billing Code Overview
CPT code 27428 describes surgical reconstruction of an intra–articular ligament of the knee, which may include use of a graft to reinforce the repair. The procedure focuses on ligaments located inside the knee joint and is a reconstructive orthopedic procedure.
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Service type: Surgical ligament reconstruction (orthopedic procedure)
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Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 28-year-old recreational soccer player presents with acute knee instability after a non-contact pivoting injury. Examination and MRI confirm a full-thickness tear of the anterior cruciate ligament (ACL) with associated intra-articular cartilage contusion. The orthopedic surgeon schedules an ACL reconstruction under general anesthesia with possible use of an autograft (hamstring or patellar tendon) to reconstruct the intra-articular ligament. The typical clinical workflow includes preoperative evaluation and imaging, informed consent, operating room arthroscopic and open work to reconstruct the torn ligament, graft harvest or allograft preparation if used, fixation of the graft within the femoral and tibial tunnels, intraoperative fluoroscopy as needed, immediate postoperative recovery in the PACU, and outpatient physical therapy for progressive rehabilitation. Typical site of service is an ambulatory surgery center or hospital outpatient department. Service type is surgical, major reconstructive orthopedic procedure of an intra-articular knee ligament.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Distinct procedural service | Used when another service or procedure is performed on the same day that is not normally reported together with the primary procedure and is distinct or independent. |
| 62 | Two surgeons | Applied when two surgeons work together as primary surgeons performing distinct portions of the procedure.