CPT 27440: Tibial Reconstruction of the Knee Joint, Reconstructive Surgery - OpenPayer

Summary & Overview

CPT 27440: Tibial Reconstruction of the Knee Joint, Reconstructive Surgery

CPT code 27440 represents reconstructive surgery of the tibial portion of the knee joint performed to relieve pain and improve gait. Nationally, this code is significant because it captures complex orthopedic interventions aimed at restoring joint function and reducing disability among patients with degenerative or traumatic tibial joint conditions. Reconstructive knee procedures drive substantial surgical resource use, influence hospital and outpatient surgical volumes, and are a focus for clinical quality and utilization management.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of coding context, common payor coverage considerations, and clinical context for the procedure. The publication presents benchmarks and utilization patterns where available, summarizes relevant policy updates affecting prior authorization and coverage, and provides clinical background to help coding, billing, and policy teams interpret use of CPT code 27440 in practice.

The content is intended for a national audience of clinicians, coding specialists, payer policy staff, and health policy analysts seeking concise guidance on the role of CPT code 27440 in surgical orthopedic care and payer interactions.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare27440CPTorthopedic surgeryknee reconstructiontibial reconstructionsurgical procedureinpatient surgeryoutpatient surgery

Billing Code Overview

CPT code 27440 describes a surgical procedure in which the provider reconstructs the diseased or damaged tibial portion of the knee joint to relieve pain and improve gait. This procedure focuses on restoring tibial joint surfaces and alignment within the knee.

Service type: Orthopedic reconstructive surgery of the tibial component of the knee joint
Typical site of service: Hospital inpatient or hospital outpatient surgical setting, including operating room environments for orthopedic procedures

Clinical & Coding Specifications

Clinical Context

A 68-year-old ambulatory patient with end-stage osteoarthritis of the knee presents with chronic medial tibial plateau pain, marked functional limitation, varus deformity, and failed conservative care (physical therapy, analgesics, intra-articular injections). After preoperative assessment and informed consent, the orthopedic surgeon schedules a tibial component reconstruction procedure to reconstruct the diseased or damaged tibial part of the knee joint to relieve pain and improve gait. The operative workflow includes preoperative templating and imaging review, intraoperative exposure of the knee via standard arthrotomy or minimally invasive approach, debridement of damaged tibial articular surface, preparation of the tibial plateau (reaming, contouring), placement of tibial augmentation or prosthetic components as indicated, intraoperative fluoroscopic confirmation, hemostasis, layered closure, and postoperative recovery with weight-bearing instructions and physical therapy planning. Typical perioperative services include anesthesia evaluation, surgical time, intraoperative imaging, implant handling, and postoperative hospital observation or discharge to home with outpatient therapy. Typical site of service is an inpatient or outpatient hospital surgical suite or ambulatory surgery center depending on patient status and institutional practice.

Coding Specifications

Modifier	Description	When to Use
`59`	Data not available in the input.	Data not available in the input.

CPT 27405: Primary Repair of Knee Collateral Ligament and Capsule

cpt-27454-femoral-osteotomy-intramedullary-rod-fixation

CPT 27454: Multiple Femoral Osteotomies with Intramedullary Rod Fixation

cpt-27396-thigh-tendon-transfer

CPT 27396: Thigh Muscle Tendon Transfer

cpt-27450-femoral-osteotomy-with-fixation

CPT 27450: Femoral Osteotomy with Fixation

27446

CPT 27446: Partial Knee Arthroplasty, Medial or Lateral Compartment

cpt-27458-femoral-lengthening-with-internal-device

CPT 27458: Femoral Osteotomy with Intramedullary Lengthening Device

cpt-27465-femoral-shortening-surgery-leg-length-discrepancy

CPT 27465: Femoral Shortening Surgery for Leg Length Discrepancy

cpt-27415-open-knee-allograft-osteochondral-repair

CPT 27415: Open Knee Allograft for Osteochondral Defect Repair

cpt-27420-patellar-tendon-transfer-bone-block

CPT 27420: Patellar Tendon Transfer with Bone Block

cpt-27470-femur-nonunion-malunion-repair-no-graft

CPT 27470: Repair of Femur Nonunion or Malunion Without Graft

Showing 1–10 of 59

Modifier	Description	When to Use
`11`	Administrative or billing placeholder for the usual/standard service (reporting professional intent).	When the procedure was performed as the usual, standard service (often reported by default).
`22`	Increased procedural services.	When the work required to perform `27440` is substantially greater than typically required.
`52`	Reduced services.	When `27440` is partially reduced or not completed as described.
`53`	Discontinued procedure.	When the procedure was started but terminated due to extenuating circumstances or those that threaten the patient's well-being.
`62`	Two surgeons.	When two surgeons work together as primary surgeons performing distinct portions of `27440`.
`66`	Surgical team.	When an organized surgical team performs `27440`.
`80`	Assistant surgeon.	When an assistant surgeon provides surgical assistance during `27440`.
`LT`	Left side.	To identify the left knee as the operative site when billing `27440`.
`RT`	Right side.	To identify the right knee as the operative site when billing `27440`.
`50`	Bilateral procedure.	When reconstruction of tibial components is performed bilaterally during the same operative session.
`26`	Professional component.	When billing a service that has a distinct professional component related to intraoperative interpretation or reporting.
`73`	Discontinued outpatient hospital/ambulatory surgery prior to anesthesia.	When `27440` was cancelled after the patient was prepared but before anesthesia in the outpatient setting.
`78`	Return to the operating room for a related procedure during the global period.	When a related unplanned return to OR for the same knee occurs during the global period following `27440`.
`79`	Data not available in the input.	Data not available in the input.

Taxonomy Code	Specialty	Notes
207X00000X	Orthopaedic Surgery	Primary specialty performing knee reconstruction and tibial component procedures.
207L00000X	Sports Medicine (Orthopaedics)	Subspecialists performing knee reconstructions, particularly in active patients.
208000000X	General Surgery	Occasionally involved in multidisciplinary or complex limb reconstruction cases.
208600000X	Surgical Oncology	In cases where tibial reconstruction is performed for tumor-related bone loss.
363LP0800X	Podiatric Surgery	Rarely involved for distal tibial or complex lower-extremity reconstructions.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M17.11`	Unilateral primary osteoarthritis, right knee	Common indication for tibial component reconstruction to relieve pain and improve gait when tibial articular surface is diseased.
`M17.12`	Unilateral primary osteoarthritis, left knee	As above, affecting the left knee.
`M17.0`	Bilateral primary osteoarthritis of knee	When both knees are affected, bilateral reconstructions or staged procedures may be planned.
`M17.9`	Osteoarthritis of knee, unspecified	General diagnosis used when side or specific type is not otherwise specified during planning for tibial reconstruction.
`M23.2`	Derangement of meniscus due to old tear or injury	Chronic meniscal damage can contribute to tibial plateau degeneration prompting reconstruction.
`M89.9`	Disorder of bone, unspecified	Used for tibial bone defects or osteonecrosis requiring reconstruction when a more specific code is not appropriate.
`M84.46`	Pathologic fracture, tibia and fibula, other	Pathologic or insufficiency fractures of the tibial plateau that necessitate reconstructive procedures.
`C79.51`	Secondary malignant neoplasm of bone, knee region	Tumor-related tibial bone loss may require reconstruction as part of oncologic limb salvage.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27447`	Arthroplasty, knee, condyle and plateau; medial OR lateral compartment.	Alternative or adjunct when addressing compartmental tibial articular disease; may be used when tibial reconstruction includes replacement of tibial plateau.
`27446`	Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty).	Performed when disease involves the entire tibial plateau and femoral components, representing conversion from isolated tibial reconstruction to total knee arthroplasty.
`27438`	Removal of prosthesis, including total knee prosthesis, including allograft when performed.	Performed when prior tibial components or implants are removed before reconstruction.
`27418`	Osteotomy, proximal tibia; for angular deformity (e.g., high tibial osteotomy).	Can be performed before or in conjunction with tibial reconstruction to correct alignment and offload the reconstructed tibial surface.
`20670`	Arthrocentesis, aspiration and/or injection; large joint or bursa.	Preoperative or postoperative joint aspirations or injections for diagnostic or therapeutic purposes in the knee perioperative period.
`73610`	Radiologic examination, knee; 2 views.	Preoperative and postoperative radiographs used for planning and confirming tibial reconstruction and component positioning.

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