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Billing code 27447: Total knee replacementMedicare rate & RVUs

Total knee replacement resurfaces the medial and lateral femoral condyles and tibial plateau, with optional patellar resurfacing, for advanced knee arthritis.

CMS RVU26DEffective Oct 1, 2026109 payment localities571.6K Medicare services in 2024

Medicare pays $1,159.35 for 27447 nationally in a facility.

Medicare rate · 27447

Total knee replacement

Swap in your local Medicare rate.

Work RVUs
19.11
Total RVUs
34.71
Global days
090

National rate · 2026

$1,159.35

Facility setting, before claim adjustments.

See every locality for 27447 → · 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 27447 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 27447 covers

An orthopedic surgeon exposes the knee, removes damaged cartilage and bone from the distal femur and proximal tibia, balances the ligaments, and places femoral and tibial components with a polyethylene insert. The components may be cemented or press-fit, and the patella may also be resurfaced. Typical indications include advanced osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis after conservative treatment has failed. Surgery is generally performed in a hospital or ambulatory surgery center.

Report one service per knee when both medial and lateral tibiofemoral compartments are replaced. The operative note should identify the compartments treated, implants placed, and whether the patella was resurfaced. Osteophyte removal, soft tissue balancing, and synovial work performed as part of the replacement are included. The 90-day global period includes the preoperative visit the day before surgery and related postoperative care. For bilateral same-session replacement, report modifier 50; Medicare pays 150%. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and additional procedures at 50%. An assistant at surgery may be paid; co-surgeons require supporting documentation. 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 27447 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

27447 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,052.72
Alaska*Unavailable$1,443.34
ArizonaUnavailable$1,128.02
ArkansasUnavailable$1,039.69
AtlantaUnavailable$1,194.44
AustinUnavailable$1,167.75
BakersfieldUnavailable$1,156.10
Baltimore/Surr. CntysUnavailable$1,229.62
BeaumontUnavailable$1,115.00
BrazoriaUnavailable$1,131.43

27447 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
27447 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 27447 rate is calculated

Each of 27447’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 · 27447

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 19.11Practice expense 11.58Malpractice 4.02

34.7100 adjusted RVUs×$33.4009 conversion factor=$1,159.35

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

Payment rules and modifiers for 27447

27447 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 27447

Total knee replacement

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 · 27447

Total knee replacement

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

27447 without 50 · national facility

$1,159.35

Total knee replacement

27447-50 · Bilateral: 150%

$1,739.03

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

27447 compared with similar codes

Compare codes

27447 vs 27446 vs 27487 vs 27438 vs 27425: national Medicare rates

Swap in your local Medicare rate.

  • 27447
    Total knee replacement · 19.11 wRVU
    —
  • 27446
    Partial knee replacement · 16.7 wRVU
    —
  • 27487
    Knee revision · 26.43 wRVU
    —
  • 27438
    Patellar arthroplasty · 11.59 wRVU
    —
  • 27425
    Patellar release · 5.26 wRVU
    —

How to choose

27446Partial knee replacement
Use 27446 when only one tibiofemoral compartment is replaced with a partial implant; use 27447 when both medial and lateral compartments are replaced.
27487Knee revision
27487 applies to revision of an existing total knee prosthesis involving the femoral and entire tibial components; 27447 describes replacement of the medial and lateral compartments rather than revision of a total knee prosthesis.
27438Patellar arthroplasty
27438 covers patellar arthroplasty with a prosthesis; when the patella is resurfaced as part of a total knee replacement, report 27447 for the replacement.
27425Patellar release
27425 describes an open lateral release. A release performed for patellar tracking during total knee replacement is included in 27447.

Codes related to 27447

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

Codes related to 27447
CodeHow it relatesNational office range
Used instead
27446Partial knee replacementReplaces only the medial or lateral tibiofemoral compartment when disease is limited to one compartment.No office rate
27438Patellar arthroplastyPatellar arthroplasty with a prosthesis for isolated patellofemoral disease instead of total knee replacement.No office rate
Often billed with
01402Anes opn/arth tot kne arthrpAnesthesia service reported by the anesthesia provider for total knee arthroplasty.No office rate
64447Femoral nerve blockFemoral nerve block may be separately reported for documented postoperative analgesia.$120.13–$175.46

27447 billing questions

Is patellar resurfacing billed separately with a total knee replacement?

No. The replacement includes patellar resurfacing when it is performed during the same operation.

Can an open lateral retinacular release be billed with this code?

A release performed for patellar tracking as part of the same knee replacement is included in the arthroplasty.

How are bilateral total knee replacements reported?

For both knees replaced in the same session, report one line with modifier 50 and one unit. Medicare pays 150% of the single-knee amount.

How is an assistant surgeon billed for this procedure?

An assistant at surgery may be paid. Physician assistants at surgery use modifier 80, 81, or 82 as appropriate; qualified nonphysician practitioners use modifier AS.

When may co-surgeons report this procedure?

Co-surgeons may be paid only when documentation supports the need for two surgeons performing distinct portions of the operation. Each surgeon reports the procedure with modifier 62.

Which visits are included in the global period?

The preoperative visit the day before surgery and related postoperative visits during the 90-day global period are included. An unrelated E/M service during that period may be reported with modifier 24 when supported.

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 27447PPRRVU2026_Oct_nonQPP.csv, line 2,899 (RVU26D)

Open CMS sourceHow we calculate rates

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