CPT code 27418: Tubercleplasty, anterior tibial tubercle advancement2026 Medicare rate & RVUs in Texas
Reports surgical advancement of the tibial tubercle to alter patellofemoral loading, typically for selected patients with persistent pain related to patellar mechanics.
CMS doesn’t publish an office rate for 27418 in Texas.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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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.
Where 27418 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | Unavailable | $773.34 |
| Beaumont, TX | Unavailable | $729.95 |
| Brazoria, TX | Unavailable | $746.84 |
| Dallas, TX | Unavailable | $754.65 |
| Fort Worth, TX | Unavailable | $752.53 |
| Galveston, TX | Unavailable | $751.08 |
| Houston, TX | Unavailable | $792.45 |
| Rest of Texas | Unavailable | $740.08 |
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
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.
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share 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.
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).
27418 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 27420Patellar reconstructionWithout extensor realignment
- Choose 27418 for tibial tubercle advancement intended to change patellofemoral loading. Code 27420 describes patellar reconstruction for dislocation.
- 27422Patellar reconstructionWith extensor realignment
- Code 27422 is for patellar-dislocation reconstruction with extensor realignment or muscle advancement; 27418 is for repositioning the tibial tubercle.
- 27425Patellar releaseOpen lateral retinacular release
- Code 27425 describes an open lateral retinacular release. It addresses lateral soft-tissue tightness rather than moving the tibial tubercle.
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
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