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    v1.0.31
    OpenPayerBilling CodesRepair, Revision, and/or Reconstruction Procedures on the Femur (Thigh Region) and Knee JointCPT cpt-27438-patellar-prosthesis-replacement
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    CPT 27438: Patellectomy with Patellar Prosthetic Replacement

    Medicare pays $796 on average nationally for this procedure.

    CPT code 27438 describes surgical repair and replacement of a damaged or painful patella with an artificial patellar prosthesis, a patellectomy with prosthetic replacement typically performed as an orthopedic reconstructive procedure; the service is an operative surgical procedure usually performed in an inpatient or outpatient hospital operating room or an ambulatory surgical center under anesthesia to relieve pain and restore knee function.

    For related coverage guidance, see recent payer policy updates: Implants for Joint Pain, Orthopedic Applications of Stem Cell Therapy, Bone Lengthening (Distraction Osteogenesis).

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is a 60-year-old female with chronic anterior knee pain and progressive patellofemoral arthritis refractory to conservative care (physical therapy, NSAIDs, corticosteroid injections). The patient reports activity-limiting pain with stair climbing and kneeling and has anterior knee crepitus and tenderness over the patella on exam. Imaging (weight-bearing radiographs and MRI) demonstrates isolated advanced patellofemoral osteoarthritis with patellar cartilage loss and subchondral changes. After failing nonoperative management, the orthopedic surgeon schedules a patellar resurfacing with patellar button prosthesis to replace the damaged patella surface to reduce pain and improve function. The clinical workflow includes preoperative evaluation (medical clearance, anesthesia assessment), perioperative administration of antibiotics, regional or general anesthesia, surgical exposure of the patella, debridement of damaged cartilage, measurement and preparation of the patellar bone, cementation and placement of a patellar button prosthesis, hemostasis, layered closure, and postoperative recovery with physical therapy and discharge planning. Typical site of service is an inpatient or outpatient hospital operating room or ambulatory surgery center depending on patient comorbidities and facility capabilities. Documentation should include indications, informed consent, intraoperative findings, device description and size, laterality (LT or RT), and any applicable modifiers for reporting professional and technical components or unusual circumstances.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    27447Arthroplasty, knee, condyle and plateau; medial OR lateral compartment (unicompartmental)Performed when unicompartmental knee replacement is indicated; may be done in combination when patellofemoral disease coexists
    27446Arthroplasty, knee, condyle and plateau; femoral and tibial components (total knee arthroplasty)Performed when disease extends beyond patellofemoral compartment requiring total knee replacement; patellar resurfacing may be performed concurrently
    27360Arthrotomy, knee, with synovectomy, limitedMay be performed for diagnostic or debridement purposes prior to or instead of resurfacing in select cases
    29881Arthroscopy, knee, surgical; with meniscal repair (medial OR lateral)Knee arthroscopy procedures may be performed prior to or in staged fashion for intra-articular pathology and assessment
    99024Postoperative follow-up visit, same physician during postoperative global period requiring evaluation and management onlyUsed to report significant postoperative follow-up care during the global period (facility or payer-specific usage)

    Related Modifiers

    11 rows

    ModifierDescriptionWhen to Use
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…

    Showing 1–10 of 11

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207LP2900X
    208800000X
    207XS0117X
    2080T0004X
    156FX1202X
    207VB0002X
    2279C0205X
    246QH0401X

    Related ICD-10-CM Codes

    21 rows

    ICD-10-CM CodeDescription
    M17.0Bilateral primary osteoarthritis of knee
    M17.11Unilateral primary osteoarthritis, right knee
    M17.12Unilateral primary osteoarthritis, left knee
    M17.2Bilateral post-traumatic osteoarthritis of knee
    M17.4Other bilateral secondary osteoarthritis of knee
    M17.5Other unilateral secondary osteoarthritis of knee
    M17.9Osteoarthritis of knee, unspecified
    M19.071Primary osteoarthritis, right ankle and foot
    M22.11Recurrent subluxation of patella, right knee
    M22.8X1Other disorders of patella, right knee

    Showing 1–10 of 21

    Related Payer Policy Updates

    Specialty: Orthopedics/Musculoskeletal1 / 3

    10 rows

    PolicyPayerEffective Date
    Implants for Joint PainBlue Cross Blue Shield - Rhode Island2027-03-01
    Orthopedic Applications of Stem Cell TherapyBlue Cross Blue Shield - Rhode Island2027-01-01
    Bone Lengthening (Distraction Osteogenesis)Blue Cross Blue Shield - North Dakota2027-01-01
    Orthopedic Joint Procedures of the Knee for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Membersuniverahealthcare2027-01-01
    Sacroiliac Joint Fusion for the Treatment of Adult Low-Back Pain Medical PolicyHealth-New-England2026-12-01
    Bone Grafts and Stabilization Devices for Spinal Defects - Medical PolicyHealth-New-England2026-12-01
    Implantable Shock Absorbers for Treatment of Knee Osteoarthritisblue cross blue shield - louisiana2026-12-01
    Autologous Chondrocyte Transplantation or Implantation Corporate Medical Policybcbsvermont2026-12-01
    Cartilage Implants for Joint Painpremerabluecrossofwashington2026-11-06
    Cartilage Implants for Joint Painpremerabluecrossofwashington2026-11-06

    Related Codes

    CPT-27380-INFRAPATELLAR-TENDON-PRIMARY-REPAIR

    CPT 27380: Primary Repair of Infrapatellar (Patellar) Tendon

    CPT-27381-SECONDARY-INFRAPATELLAR-TENDON-REPAIR

    CPT 27381: Secondary Repair of Infrapatellar Tendon

    CPT-27385-HAMSTRING-QUADRICEPS-RUPTURE-REPAIR-SUTURE

    CPT 27385: Primary Repair of Hamstring or Quadriceps Rupture

    CPT-27386-SECONDARY-QUADRICEPS-HAMSTRING-REPAIR-AUTOGRAFT

    CPT 27386: Secondary Repair of Quadriceps or Hamstring with Graft

    CPT-27390-OPEN-TENOTOMY-HAMSTRING-SINGLE-TENDON

    CPT 27390: Open Tenotomy of Hamstring Tendon

    CPT-27391-OPEN-HAMSTRING-TENOTOMY

    CPT 27391: Open Tenotomy of Multiple Hamstring Tendons

    CPT-27392-OPEN-TENOTOMY-HAMSTRING-BILATERAL

    CPT 27392: Open Bilateral Hamstring Tenotomy

    CPT-27393-HAMSTRING-TENDON-LENGTHENING

    CPT 27393: Hamstring Tendon Lengthening

    CPT-27394-HAMSTRING-TENDON-LENGTHENING-UNILATERAL

    CPT 27394: Hamstring Tendon Lengthening, Unilateral

    CPT-27395-HAMSTRING-TENDON-LENGTHENING-BILATERAL

    CPT 27395: Bilateral Hamstring Tendon Lengthening

    Showing 1–10 of 59

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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