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Billing code 27418: TubercleplastyMedicare rate & RVUs

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, 2026109 payment localities123 Medicare services in 2024

Medicare pays $763.21 for 27418 nationally in a facility.

Medicare rate · 27418

Tubercleplasty

Swap in your local Medicare rate.

Work RVUs
11.31
Total RVUs
22.85
Global days
090

National rate · 2026

$763.21

Facility setting, before claim adjustments.

See every locality for 27418 → · Billed by an NP, PA or therapist? →

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

On this page 10 sections
  1. Medicare rate
  2. What 27418 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. 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.

Where 27418 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

27418 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$691.70
Alaska*Unavailable$938.35
ArizonaUnavailable$742.73
ArkansasUnavailable$682.90
AtlantaUnavailable$784.48
AustinUnavailable$773.34
BakersfieldUnavailable$770.63
Baltimore/Surr. CntysUnavailable$809.77
BeaumontUnavailable$729.95
BrazoriaUnavailable$746.84

27418 rates by state

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

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Local rates. Clear comparisons.

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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

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

Swap in your local Medicare rate.

Work 11.31Practice expense 9.28Malpractice 2.26

22.8500 adjusted RVUs×$33.4009 conversion factor=$763.21

All indexes start 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

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

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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

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

27418 compared with similar codes

Compare codes

27418 vs 27420 vs 27422 vs 27425: national Medicare rates

Swap in your local Medicare rate.

  • 27418
    Tubercleplasty · 11.31 wRVU
    —
  • 27420
    Patellar reconstruction · 10 wRVU
    —
  • 27422
    Patellar reconstruction · 9.95 wRVU
    —
  • 27425
    Patellar release · 5.26 wRVU
    —

How to choose

27420Patellar reconstruction
Choose 27418 for tibial tubercle advancement intended to change patellofemoral loading. Code 27420 describes patellar reconstruction for dislocation.
27422Patellar reconstruction
Code 27422 is for patellar-dislocation reconstruction with extensor realignment or muscle advancement; 27418 is for repositioning the tibial tubercle.
27425Patellar release
Code 27425 describes an open lateral retinacular release. It addresses lateral soft-tissue tightness rather than moving the tibial tubercle.

Codes related to 27418

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 27418
CodeHow it relatesNational office range
Used instead
27420Patellar reconstructionPatellar reconstruction for dislocation is a different approach when instability, rather than tubercle advancement, is the operative target.No office rate
27422Patellar reconstructionAddresses patellar dislocation with extensor realignment or muscle advancement rather than tibial tubercle advancement.No office rate
27425Patellar releaseOpen lateral retinacular release addresses lateral soft-tissue tightness, not bony advancement of the tibial tubercle.No office rate

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)

Open CMS sourceHow we calculate rates

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