CPT code 27418: Tubercleplasty, anterior tibial tubercle advancement2026 Medicare rate & RVUs in Montana

Reports surgical advancement of the tibial tubercle to alter patellofemoral loading, typically for selected patients with persistent pain related to patellar mechanics.

CMS RVU26DEffective Oct 1, 2026One payment locality123 Medicare services in 2024

In Montana, Medicare pays $763.06 for 27418 in a facility. There’s no office rate.

Not available in this settingOffice (non-facility)
$763.06Hospital or facility

Check a contract rate as a % of Medicare · 27418 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 27418 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Montana
  2. What 27418 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 27418 covers

The surgeon cuts and repositions the tibial tubercle—the bony prominence below the kneecap where the patellar tendon attaches—to shift the patella’s loading pattern. This procedure is used in selected patients with persistent patellofemoral pain or abnormal patellar mechanics; it is not simply a repair of kneecap tissue. An orthopedic surgeon typically performs it in a surgical facility, with the patellar tendon remaining attached to the moved bone segment.

Report 27418 when the operative work includes this tibial tubercle advancement, rather than a procedure directed primarily at reconstructing patellar restraints or treating a cartilage defect. The record should identify the indication, side, relevant examination or imaging findings, and the osteotomy and repositioning performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Montana compares for 27418

Across 109 of 109 payment localities, the facility rate for 27418 runs from $682.90 in Arkansas to $938.35 in Alaska. Montana pays $763.06. The RVUs are the same everywhere; the geographic indexes change the dollars.

27418 in Montana vs other payment areas
  1. Montana · this page$763.06
  2. Los Angeles, CA · California$810.06+$47.00
  3. Washington, DC area · District of Columbia$847.31+$84.25
  4. Miami, FL · Florida$891.34+$128.28
  5. Chicago, IL · Illinois$865.16+$102.10
  6. Manhattan, NY · New York$881.84+$118.78
  7. Alaska · Alaska$938.35+$175.29

Other areas in Montana first, then benchmark localities. Bars start at $0.

Every other payment area

27418 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama—$691.70
ArkansasArkansas—$682.90
ArizonaArizona—$742.73
Bakersfield, CACalifornia—$770.63
Chico, CACalifornia—$764.36
El Centro, CACalifornia—$764.74
Fresno, CACalifornia—$764.36
Hanford, CACalifornia—$764.36

27418 rates by state

Office rate range in each state. Select a state to see its payment localities.

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
27418 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

See 27418 in every payment locality

How the 27418 rate is calculated

Each of 27418’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 27418

RVUs × geographic indexes × conversion factor

Office or facility?

Work11.31

11.31 RVUs× 1.000 GPCI

Practice expense9.28

9.28 RVUs× 1.000 GPCI

Malpractice2.26

2.26 RVUs× 1.000 GPCI

Adjusted RVUs

22.8500

Conversion factor

$33.4009

Medicare rate

$763.21

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Montana inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

2,882

Code
27418
Physician work
11.31
Practice expense
9.28
Malpractice
2.26

GPCI2026.csv

71

Locality
Montana
Physician work
1.000
Practice expense
1.000
Malpractice
0.998
Facility calculation for 27418 in Montana
ComponentRVULocality factorAdjusted
Physician work11.31× 1.00011.3100
Practice expense9.28× 1.0009.2800
Malpractice2.26× 0.9982.2555
Total RVUs22.8455
Conversion factor× 33.4009

Facility rate, Montana$763.06

Facility: (11.31 × 1 + 9.28 × 1 + 2.26 × 0.998) × $33.4009 = $763.06

Open 27418 in the RVU calculator

Payment rules and modifiers for 27418

27418 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 27418

Tubercleplasty, anterior tibial tubercle advancement

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.69/0.21Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 27418

Tubercleplasty, anterior tibial tubercle advancement

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

27418 without 50 · national facility

$763.21

Tubercleplasty, anterior tibial tubercle advancement

27418-50 · Bilateral: 150%

$1,144.82

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

How 27418 has changed in Montana

27418 · Office / nonfacility

Rate unavailable

Effective 2026-10-01

A rate is unavailable in one of these releases, so a change cannot be calculated.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release
Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01Not available in this setting$763.06RVU26D
2026-07-01Not available in this setting$763.06RVU26C
2026-04-01Not available in this setting$763.06RVU26B
2026-01-01Not available in this setting$763.06RVU26A
2025-10-01Not available in this setting$806.50RVU25D
2025-07-01Not available in this setting$806.50RVU25C
2025-04-01Not available in this setting$806.50RVU25B
2025-01-01Not available in this setting$806.50RVU25A
2024-10-01Not available in this setting$828.26RVU24D
2024-07-01Not available in this setting$828.26RVU24C
2024-04-01Not available in this setting$828.26RVU24B
2024-03-09Not available in this setting$828.26RVU24AR
2024-01-01Not available in this setting$814.74RVU24A
2023-10-01Not available in this setting$844.49RVU23D
2023-07-01Not available in this setting$844.49RVU23C
2023-04-01Not available in this setting$844.49RVU23B
2023-01-01Not available in this setting$844.49RVU23A
2022-10-01Not available in this setting$854.32RVU22D
2022-07-01Not available in this setting$854.32RVU22C
2022-04-01Not available in this setting$854.32RVU22B
2022-01-01Not available in this setting$854.32RVU22A
2021-10-01Not available in this setting$855.19RVU21D
2021-07-01Not available in this setting$855.19RVU21C
2021-04-01Not available in this setting$855.19RVU21B
2021-01-01Not available in this setting$855.19RVU21A
2020-10-01Not available in this setting$887.29RVU20D
2020-07-01Not available in this setting$887.29RVU20C
2020-04-01Not available in this setting$887.29RVU20B
2020-01-01Not available in this setting$887.29RVU20A
2019-10-01Not available in this setting$910.93RVU19D
2019-07-01Not available in this setting$910.93RVU19C
2019-04-01Not available in this setting$910.93RVU19B
2019-01-01Not available in this setting$910.93RVU19A
2018-10-01Not available in this setting$904.47RVU18D
2018-07-01Not available in this setting$904.47RVU18C
2018-04-01Not available in this setting$904.47RVU18B
2018-01-01Not available in this setting$904.47RVU18AR1
2017-10-01Not available in this setting$884.02RVU17D
2017-07-01Not available in this setting$884.02RVU17C
2017-04-01Not available in this setting$884.02RVU17B
2017-01-01Not available in this setting$884.02RVU17A
2016-10-01Not available in this setting$871.23RVU16D
2016-07-01Not available in this setting$871.23RVU16C
2016-04-01Not available in this setting$871.23RVU16B
2016-01-01Not available in this setting$871.23RVU16A
2015-10-01Not available in this setting$874.09RVU15D
2015-07-01Not available in this setting$874.09RVU15C
2015-04-01Not available in this setting$869.74RVU15B
2015-01-01Not available in this setting$869.74RVU15A
2014-10-01Not available in this setting$861.77RVU14D
2014-07-01Not available in this setting$861.77RVU14C
2014-04-01Not available in this setting$861.77RVU14B
2014-01-01Not available in this setting$861.77RVU14A
2013-10-01Not available in this setting$848.97RVU13D
2013-07-01Not available in this setting$848.97RVU13C
2013-04-01Not available in this setting$848.97RVU13B
2013-01-01Not available in this setting$848.97RVU13AR

Price 27418 for an earlier date of service

Where the Montana rate applies

Montana is a Medicare payment area, not a city. Our Census mapping connects it to 497 cities and communities in Montana. Some span more than one payment area; confirm with the service ZIP.

  • Absarokee
  • Acton
  • Alberton
  • Alder
  • Alzada
  • Amsterdam
  • Anaconda-Deer Lodge County
  • Antelope

Browse all communities in Montana

27418 billing questions

How does 27418 differ from 27422?

27418 describes advancement of the tibial tubercle to change patellofemoral loading. Use 27422 when the operation is a patellar-dislocation reconstruction involving extensor realignment or muscle advancement.

What documentation supports 27418?

Document the patellofemoral indication, the operative side, relevant clinical or imaging findings, and the tibial tubercle osteotomy and repositioning performed.

Does the 90-day global include routine postoperative care?

Yes. The global period includes the day-before preoperative visit and 90 days of related postoperative care.

How is bilateral 27418 reported?

CMS lists this as a bilateral procedure; reporting modifier 50 is paid at 150%.

Can an assistant or co-surgeon be paid?

Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is not permitted.

What happens when another procedure is performed in the same session?

Under the standard multiple-procedure rule, the highest-valued procedure is paid in full and the other procedures are paid at 50%.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 27418PPRRVU2026_Oct_nonQPP.csv, line 2,882 (RVU26D)
Geographic factors for MontanaGPCI2026.csv, line 71 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 27418 pays in Montana?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets

Put 27418 and the rest of your codes on one sheet

Your codes at your locality, with payer contracts beside Medicare.

Build my fee sheet