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Billing code 27428: Knee reconstructionMedicare rate & RVUs

Report this procedure for surgical reconstruction of an intra-articular knee ligament, commonly a cruciate ligament, when reconstruction rather than direct repair is performed.

CMS RVU26DEffective Oct 1, 2026109 payment localities63 Medicare services in 2024

Medicare pays $1,040.44 for 27428 nationally in a facility.

Medicare rate · 27428

Knee reconstruction

Swap in your local Medicare rate.

Work RVUs
15.19
Total RVUs
31.15
Global days
090

National rate · 2026

$1,040.44

Facility setting, before claim adjustments.

See every locality for 27428 → · 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 27428 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 27428 covers

This service reconstructs a ligament within the knee joint, commonly a cruciate ligament, to restore stability when the ligament cannot be adequately treated with direct repair. An orthopedic surgeon performs the reconstruction in an operating room, typically using a graft to replace or augment the deficient ligament. The operative report should identify the ligament treated, the intra-articular reconstruction performed, and the reason reconstruction was selected.

Report 27428 for the intra-articular portion of the reconstruction; use the related code for an extra-articular reconstruction or for a procedure combining both locations. The day-before preoperative visit and 90 days of related postoperative care are included in the major-surgery global period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 identifies a bilateral procedure, paid at 150%. An assistant at surgery may be paid; co-surgeons require 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 27428 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

27428 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$940.47
Alaska*Unavailable$1,273.32
ArizonaUnavailable$1,011.72
ArkansasUnavailable$928.16
AtlantaUnavailable$1,070.45
AustinUnavailable$1,053.82
BakersfieldUnavailable$1,048.71
Baltimore/Surr. CntysUnavailable$1,105.16
BeaumontUnavailable$994.51
BrazoriaUnavailable$1,016.94

27428 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.

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
27428 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 27428 rate is calculated

Each of 27428’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 · 27428

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 15.19Practice expense 12.73Malpractice 3.23

31.1500 adjusted RVUs×$33.4009 conversion factor=$1,040.44

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 27428

27428 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 27428

Knee reconstruction

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 · 27428

Knee reconstruction

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

27428 without 50 · national facility

$1,040.44

Knee reconstruction

27428-50 · Bilateral: 150%

$1,560.66

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

27428 compared with similar codes

Compare codes

27428 vs 27427 vs 27429 vs 27407 vs 29888: national Medicare rates

Swap in your local Medicare rate.

  • 27428
    Knee reconstruction · 15.19 wRVU
    —
  • 27427
    Knee reconstruction · 9.55 wRVU
    —
  • 27429
    Knee reconstruction · 17.1 wRVU
    —
  • 27407
    Cruciate ligament repair · 10.58 wRVU
    —
  • 29888
    ACL surgery · 13.94 wRVU
    —

How to choose

27427Knee reconstruction
27427 is for extra-articular knee ligament reconstruction. 27428 applies when the reconstruction is intra-articular.
27429Knee reconstruction
27429 describes reconstruction involving both intra-articular and extra-articular work; 27428 describes the intra-articular reconstruction.
27407Cruciate ligament repair
27407 is for knee ligament repair. Choose 27428 when the documented procedure reconstructs an intra-articular ligament instead.
29888ACL surgery
29888 is for arthroscopically aided ACL repair, augmentation, or reconstruction. 27428 describes intra-articular knee ligament reconstruction outside that arthroscopically aided ACL code.

Codes related to 27428

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

Codes related to 27428
CodeHow it relatesNational office range
Same family
27427Knee reconstructionRelated knee ligament reconstruction code for extra-articular work.No office rate
27429Knee reconstructionRelated code for reconstruction involving both intra-articular and extra-articular work.No office rate
Used instead
27407Cruciate ligament repairKnee ligament repair may be appropriate when the ligament is repaired rather than reconstructed.No office rate
29888ACL surgeryArthroscopically aided ACL reconstruction is reported with this code when its requirements are met.No office rate

27428 billing questions

How is 27428 distinguished from 27427 and 27429?

Use 27428 for an intra-articular ligament reconstruction. Code 27427 describes an extra-articular reconstruction, while 27429 describes reconstruction involving both intra-articular and extra-articular work.

When is reconstruction reported instead of 27407?

Code 27428 describes intra-articular reconstruction, commonly involving a graft. Code 27407 is for repair of a knee ligament, rather than this intra-articular reconstruction.

What documentation supports 27428?

The operative report should identify the ligament reconstructed, document the intra-articular work, and explain the reconstruction performed. It should distinguish that work from direct ligament repair or an extra-articular procedure.

Does the 90-day global period include postoperative visits?

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

How are bilateral procedures and additional same-session procedures handled?

Modifier 50 identifies a bilateral procedure, which is paid at 150%. For multiple procedures in one session, the highest-valued procedure is paid in full and the others 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 27428PPRRVU2026_Oct_nonQPP.csv, line 2,888 (RVU26D)

Open CMS sourceHow we calculate rates

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