Find policies, billing codes, payers, states, and providers
CPT 27486: Revision Arthroplasty of One Knee Component
CPT code 27486 denotes a revision arthroplasty of a single knee component — the removal and replacement of a previously implanted prosthetic component, with optional use of allograft. This procedure is nationally significant because revision knee arthroplasty addresses implant failure, infection, wear, or instability and carries higher resource utilization, longer operative times, and increased complication risk compared with primary arthroplasty. Payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare.
Readers will find a concise overview of clinical context for revision knee components, common sites of service, and how 27486 relates to adjacent knee and femoral procedure codes. The publication summarizes benchmark considerations across major payers, typical billing practices, and common companion codes used in the perioperative period. It also outlines documentation elements relevant to clinical indication and operative findings that justify revision intervention. The content is designed for health system coding teams, orthopedic clinicians, and revenue cycle professionals seeking a clear national perspective on clinical use and payer coverage patterns for revision of a single knee component.
Customize your policy alerts
Sign up for cpt 27486 policy alerts
Get alerted when payer policies referencing 27486 are released or updated.
Monitor payer policy activity
Billing Code Overview
CPT code 27486 describes a revision arthroplasty of any one component of the knee joint, a surgical procedure in which a previously implanted prosthetic knee component is removed and replaced with a new prosthesis. The procedure may include the use of an allograft but does not require one.
Service type: Surgical — Orthopaedic revision procedure
Typical site of service: Inpatient hospital or outpatient surgical center, depending on patient condition and complexity of the revision.
National Reimbursement Benchmarks
Medicare’s mean rate of $1,293.80 sits below BUCA’s average commercial mean of $5,226.50, illustrating a substantial gap between government and commercial reimbursement for CPT 27486. The commercial mean is roughly four times Medicare’s, signaling materially higher payment levels in commercial contracts represented by BUCA compared with the Medicare program’s national average.
Dispersion measured as P75 minus P25 highlights meaningful variation across payers. Blue Cross Blue Shield shows the widest interquartile spread at $11,210.50 (P75 $13,210.40 minus P25 $1,569.50), followed by BUCA at $7,270.70 (P75 $8,630.40 minus P25 $1,359.70). The tightest spreads are Aetna at $1,225.00 and Cigna at $1,588.30, with UnitedHealth Group showing moderate dispersion of $1,520.50, indicating differing levels of rate concentration across payers.