CPT 27447: Total Knee Replacement (Total Knee Arthroplasty)
27447 reports a total knee arthroplasty: the surgeon replaces the joint surfaces of the knee with a prosthesis, working on both the medial and lateral compartments and either resurfacing the kneecap or leaving it. It is a major surgery with a 90-day global period, and the claim questions it raises mostly concern two knees in one session and where the patient is admitted.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026In short: 27447 is a 090-day major surgery that Medicare pays once per knee, with an MUE of 1. Both knees in one session are reported with modifier 50 or, with two surgeons, modifier 62, and hospitals bill it on an inpatient or an outpatient claim.
What Does CPT 27447 Report?
27447 is the procedure code for replacing the knee joint, called a total knee arthroplasty. The CMS fee schedule file prints the short label "Total knee arthroplasty".
| Item | Value in RVU26D, October 2026 |
|---|---|
| Payment status | A (active code) |
| Work RVU | 19.11 |
| Facility total RVU | 34.71 |
| Non-facility practice expense | NA (rarely or never performed in the non-facility setting) |
| Global period | 090, split 10 percent before, 69 percent during, 21 percent after surgery |
| Bilateral surgery indicator | 1 (150 percent adjustment applies) |
| Co-surgeon indicator | 1 (supporting documentation required) |
| Team surgery indicator | 0 (not permitted) |
| Practitioner MUE, effective 10-01-2026 | 1 (indicator 2, a policy edit) |
How Is the Visit That Decides on Surgery Billed?
An evaluation on the day before or the day of a major surgery that results in the decision to operate is paid separately, with modifier 57. Chapter 12, section 40.2 A.4, adds that on the day of surgery the physician uses 57 and not 25.
NCCI Chapter I adds that other preoperative E/M services on the date of a 090-day procedure are included in the global payment. The contents of the 90-day package are covered under orthopedic billing and the global surgery periods rule.
How Are Two Knees in One Session Reported?
One surgeon doing both knees reports 27447 with modifier 50 on a single line with 1 unit. Chapter 12, section 40.7, requires that single line, and the file's bilateral indicator of 1 means payment is the lower of the billed amount or 150 percent of the fee schedule amount for the pair. NCCI Chapter IV says MUE values for bilateral procedures assume that single line, which fits the MUE of 1.
Two surgeons of different specialties are another case. Chapter 12, section 40.8, names bilateral knee replacements as an example of co-surgery, where each surgeon bills 27447 with modifier 62 and the fee schedule amount for each is 62.5 percent of the global amount. The file's co-surgeon indicator of 1 means documentation of the need for two surgeons is required, and team surgery is not permitted. Section 40.9 lists 50 with 62 as an allowed combination.
Dr. A and Dr. B, in different specialties, each replace one knee in one session. Each bills 27447 with modifier 62 and the note explaining why two surgeons were needed. If Dr. A did both knees alone, the claim is one line, 27447-50, 1 unit.
Is a Total Knee Replacement Inpatient or Outpatient?
It can be either. The CY 2026 OPPS final rule recalls that total knee arthroplasty was removed from the inpatient only list in the CY 2018 OPPS/ASC final rule, and Chapter 4, section 180.7, says procedures taken off the list may be furnished in the inpatient or the outpatient setting and remain payable when inpatient.
The same rule finalized eliminating the inpatient only list over three years. Per Chapter 1, an outpatient hospital claim uses bill type 13x and an inpatient stay uses 11x, and Part A payment for a stay still turns on the two-midnight rule.
Do TEAM and CJR Change How 27447 Is Billed?
Not on the claim line. CMS says TEAM participants continue to bill Medicare fee-for-service as usual. TEAM is mandatory for selected acute care hospitals from January 1, 2026 to December 31, 2030, and lower extremity joint replacement is one of its five included procedures.
The earlier Comprehensive Care for Joint Replacement model ran from April 1, 2016 to December 31, 2024. CJR-X, finalized in the FY 2027 IPPS rule, will be mandatory nationwide beginning January 1, 2028 and covers the first 90 days of recovery.
How Does 27447 Appear on the Claim?
On the CMS-1500, Item 24D carries 27447 with modifier 50 or 62 as the case requires (the decision visit is its own line with 57), Item 24G carries 1, and Item 24B carries 21 for an inpatient, 22 for an on-campus outpatient department or 19 for an off-campus one. The file marks the non-facility setting NA, meaning the procedure is rarely or never performed there.
Approval rules vary by payer, so the prior authorization request should be on file before surgery.
Where Do the Knee, Side and Units Go for 27447?
A knee replacement is one line in Item 24D with 1 unit in Item 24G and the date in Item 24A. A second knee in the same session uses modifier 50 or RT and LT per the payer. Item 24E points to the knee diagnosis, and the surgeon's place of service reflects the inpatient or outpatient setting.
On the hospital side, an outpatient claim carries 27447 in FL 44. On an inpatient claim, Chapter 25 puts the principal procedure code and date in FL 74, which is not used on outpatient claims.
RVU26D gives 27447 status A, a 090 global, bilateral indicator 1 and assistant indicator 2. The MUE table allows 1 per date with indicator 2.
Example: A patient has a right total knee replacement on 10/20. The line is 27447 RT, pointer A (M17.11), 1 unit, $2,850.00. For both knees on one date the payer may want 27447 50 with 1 unit or two lines, so confirm the payer's rule before billing.
Why Is 27447 Denied?
| CARC | What X12 says | What usually causes it |
|---|---|---|
| 197 | Precertification, authorization or notification absent | No approval number for a commercial or Medicare Advantage plan |
| 18 | Exact duplicate claim or service (OA) | Both knees on two lines without modifier 50 or 62 |
| 5 | The procedure code or type of bill is inconsistent with the place of service | Outpatient POS or bill type on a stay registered as inpatient |
| 50 | Non-covered because the payer does not deem it medically necessary | Conservative treatment history missing from the record |
If these denials keep coming back, our denial management team can work them. Compare the hip: CPT 27130.
Related Codes
- Physician Fee Schedule relative value files, RVU26D (October 2026) · CMS
- Medicare NCCI Medically Unlikely Edits, practitioner and outpatient hospital tables, effective 10-01-2026 · CMS
- Medicare Claims Processing Manual, Chapter 12: Physicians/Nonphysician Practitioners · CMS
- Medicare Claims Processing Manual, Chapter 4: Part B Hospital (Including Inpatient Hospital Part B and OPPS) · CMS
- Medicare Claims Processing Manual, Chapter 1: General Billing Requirements · CMS
- Medicare Claims Processing Manual, Chapter 26: Completing and Processing Form CMS-1500 Data Set · CMS
- 2026 NCCI Medicare Policy Manual, Chapter I: General Correct Coding Policies · CMS
- 2026 NCCI Medicare Policy Manual, Chapter IV: Musculoskeletal System · CMS
- CY 2026 OPPS and ASC final rule (90 FR 53448) · Federal Register
- TEAM (Transforming Episode Accountability Model) · CMS
- Comprehensive Care for Joint Replacement Model · CMS
- CJR-X (Comprehensive Care for Joint Replacement Expanded) Model · CMS
- Claim Adjustment Reason Codes · X12
- Medicare Claims Processing Manual, Chapter 25: Completing and Processing the Form CMS-1450 Data Set · CMS
We check every rule, code and deadline against the official source. See our editorial policy.
Common Questions
Straight answers from the team that does the work.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01What does CPT 27447 mean?
It reports a total knee arthroplasty, where the knee joint surfaces are replaced and both the medial and lateral compartments are treated, with or without resurfacing the kneecap. The CMS fee schedule file labels it Total knee arthroplasty and lists a work RVU of 19.11.
02What is included in the global period for a total knee replacement?
A 090 global: one day before surgery, the day of surgery and 90 days after. It covers related visits, routine postoperative care and complications that do not need a return to the operating room. Chapter 12 section 40.1 lists the inclusions and the exclusions.
03How do I bill bilateral total knee replacements?
One surgeon reports 27447 with modifier 50, one line and 1 unit, and payment is the lower of the billed amount or 150 percent. Two surgeons in different specialties each bill 27447 with modifier 62, with documentation, and each is paid 62.5 percent of the global amount.
04Is 27447 on the inpatient only list?
No. The CY 2026 OPPS final rule recalls that total knee arthroplasty was removed in the CY 2018 final rule, and Chapter 4 section 180.7 says removed procedures may be done as inpatient or outpatient. Part A inpatient payment still depends on the two-midnight rule.
05Does TEAM change how a surgeon bills 27447?
CMS states that TEAM participants continue to bill Medicare fee-for-service as usual. TEAM applies to selected hospitals from January 1, 2026 and holds them to a target price for the episode, which ends 30 days after discharge. The surgeon's claim line is unchanged.
Joint Replacement Claims on Hold?
We check the modifier set, the bill type and the approval number before the claim goes out.