Summary & Overview
CPT 27695: Repair of Single Collateral Ligament of Knee
CPT code 27695 designates surgical repair of a single collateral ligament of the knee (medial or lateral) following an acute injury such as a dislocation or severe sprain. This code captures a targeted operative intervention intended to restore stability, relieve pain, and reestablish function, making it clinically important for trauma and sports medicine pathways and for postoperative care planning. Nationally, accurate coding for ligament repair affects surgical quality tracking, post-acute care coordination, and payer authorization workflows.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical settings where the service is delivered (hospital OR and ambulatory surgery centers), and the role of this code in claims and utilization monitoring. The publication also covers common billing modifiers and related administrative considerations where available, benchmark patterns across major payers, and policy updates that influence coverage and prior authorization requirements. Data not available in the input for some specific reimbursement benchmarks and associated diagnosis codes is noted where applicable.
Billing Code Overview
CPT code 27695 describes a surgical repair of a single collateral ligament of the knee — either the medial collateral ligament (MCL) or the lateral collateral ligament (LCL) — that is disrupted by an acute injury such as a dislocation or severe sprain. The procedure is performed to restore joint stability, reduce pain, and return function to the affected knee.
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Service type: Surgical ligament repair
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Typical site of service: Hospital operating room or ambulatory surgery center
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Clinical & Coding Specifications
Clinical Context
A 34-year-old male construction worker presents to the emergency department after a fall from scaffolding with a visibly swollen and unstable knee following a lateral dislocation. He reports immediate pain and inability to bear weight. Physical exam demonstrates valgus instability at the knee and tenderness along the medial joint line. Radiographs exclude fracture; MRI confirms an acute disruption of the medial collateral ligament (MCL) with retraction and associated capsule injury. After urgent orthopedic evaluation, the patient is taken to the operating room for surgical repair of the single collateral ligament to restore joint stability and relieve pain.
Preoperative workflow includes informed consent, documentation of acute mechanism and clinical instability, review of imaging demonstrating ligament disruption, and anesthesia assessment. Intraoperative documentation lists the ligament repaired (medial collateral ligament), technique used (direct primary repair with suture anchors), laterality, estimated blood loss, and any concurrent procedures. Postoperative plan documents immobilization, pain control, and physical therapy timeline for progressive range of motion and strengthening.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the repair is significantly more complex or time-consuming than typical and documentation supports unusual work. |