Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.31
    OpenPayerBilling CodesRepair, Revision, and/or Reconstruction Procedures on the Femur (Thigh Region) and Knee JointCPT cpt-27488-removal-total-knee-prosthesis-cemented
    Ask Trek AI about this page

    CPT 27488: Explantation of Total Knee Prosthesis with Cement Removal

    Medicare pays $1117 and commercial payers pay $3157 on average nationally for this procedure.

    CPT code 27488 describes surgical removal of a total knee prosthesis with breaking and removal of methylmethacrylate bone cement, a procedure performed in an operative setting as an orthopedic revision/explantation of a knee implant and typically done in an inpatient or ambulatory surgical center operating room; the surgeon may elect to place or not place a spacer in the joint space after prosthesis removal.

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

    Customize your policy alerts

    Sign up for cpt 27488 policy alerts

    Get alerted when payer policies referencing 27488 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    National Reimbursement Benchmarks

    Across national payers, Medicare’s mean rate of $1,117.40 sits below BUCA’s average commercial mean of $3,156.60, indicating a substantial gap between federal reimbursement and this commercial benchmark. The difference of $2,039.20 highlights that BUCA’s average commercial payments are roughly 2.8 times higher than Medicare for CPT 27488, emphasizing commercial market premiuming versus government schedules.

    Dispersion varies notably by payer when measured as P75 minus P25: Blue Cross Blue Shield shows the widest interquartile spread at $2,524.00 (P75 $5,004.80 minus P25 $2,480.90), followed by UnitedHealth Group at $1,303.40 and Cigna at $1,362.70. Aetna is comparatively tight with a spread of $372.00, and BUCA’s interquartile range is $1,970.40. Medicare’s spread is modest at $84.00 (P75 $1,153.00 minus P25 $1,069.00), indicating relatively low regional variability.

    Table of contents

    Progress1 / 9

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • Facility ComparisonBeds, revenue & payer mix
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools
    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old patient with a prior total knee arthroplasty presents with increasing knee pain, decreased function, and radiographic evidence of loosening and cement mantle breakdown around the tibial and/or femoral components. The patient has signs suggestive of a mechanical complication or pain due to the internal prosthesis (T84.83XA, T84.84XA) and is scheduled for surgical removal of the total knee prosthesis with extraction of methylmethacrylate bone cement. Preoperative workflow includes orthopedic consultation by an Adult Reconstructive Orthopaedic Surgery Physician, review of prior operative reports and implant records, plain radiographs and possible CT for component position and cement assessment, and routine preoperative labs and anesthesia evaluation. Intraoperatively the surgeon removes prosthetic components and breaks or extracts methylmethacrylate cement; a temporary antibiotic spacer may be inserted depending on infection workup and staging. Postoperative care includes pain control, thromboprophylaxis, wound care, and planning for either definitive revision arthroplasty at a later date or continued spacer management. Typical site of service is an inpatient or outpatient hospital operating room depending on complexity and comorbidities; ambulatory surgery center use may be limited by expected operative time, need for implants, or potential staged reconstruction.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    27447

    Related Modifiers

    9 rows

    ModifierDescriptionWhen to Use
    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…
    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…
    54Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
    55Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
    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…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207X00000X
    207XS0114X
    364SN0000X
    208G00000X
    347C00000X
    320800000X
    2081H0002X
    1835P0200X

    Related ICD-10-CM Codes

    23 rows

    ICD-10-CM CodeDescription
    M06.072Rheumatoid arthritis without rheumatoid factor, left ankle and foot
    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
    M24.561Contracture, right knee
    M24.569Contracture, unspecified knee

    Showing 1–10 of 23

    Related Payer Policy Updates

    Specialty: Orthopedics/Musculoskeletal1 / 3

    10 rows

    PolicyPayerEffective Date
    Implants for Joint PainBlue Cross Blue Shield - Rhode Island2027-03-01
    Bone Lengthening (Distraction Osteogenesis)regence2027-01-01
    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

    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.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Total knee arthroplasty
    Primary procedure for initial knee replacement; may be referenced when comparing index operation or planning reimplantation after removal.
    27486Revision of total knee arthroplasty; one componentRevision procedure that may follow cement and component removal if only one component requires exchange.
    27487Revision of total knee arthroplasty; femoral and entire tibial componentMore extensive revision code used when both femoral and tibial components are revised after explantation.
    20680Removal of implant; deep (e.g., buried wire, pin, screw, metal band, nail, rod or plate)Related to removal of deep fixation hardware; used when separate deep implants are removed in addition to prosthesis and cement extraction.