No office rate
Choose 27418 for tibial tubercle advancement intended to change patellofemoral loading. Code 27420 describes patellar reconstruction for dislocation.
On this page
CMS RVU26D · Effective 2026-10-01
27418 in Modesto
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$764.36
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Orthopedic surgery
About 27418: Anterior tibial tubercle advancement
Reports surgical advancement of the tibial tubercle to alter patellofemoral loading, typically for selected patients with persistent pain related to patellar mechanics.
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.
CMS billing rules for 27418
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU11.31 · 49%
- Practice expense (office) RVU9.28 · 41%
- Malpractice RVU2.26 · 10%
123
Medicare services in 2024 · #4714 by national volume
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.
27418 compared with similar codes
Office rates for Modesto, from the same CMS release.
No office rate
Code 27422 is for patellar-dislocation reconstruction with extensor realignment or muscle advancement; 27418 is for repositioning the tibial tubercle.
No office rate
Code 27425 describes an open lateral retinacular release. It addresses lateral soft-tissue tightness rather than moving the tibial tubercle.
The same code, a different location
How does Modesto compare?
27418 across payment areas
Same release and payment basis · bars start at $0
Modesto · This locality
Unavailable
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
No comparable rate is available in this setting.
Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Madera
California · 27418
Office
Unavailable
Facility
$764.36
No comparable office rate is available.
Merced
California · 27418
Office
Unavailable
Facility
$764.36
No comparable office rate is available.
Napa
California · 27418
Office
Unavailable
Facility
$848.44
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 27418
Office
Unavailable
Facility
$801.74
No comparable office rate is available.
Redding
California · 27418
Office
Unavailable
Facility
$764.36
No comparable office rate is available.
Rest Of California
California · 27418
Office
Unavailable
Facility
$764.36
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 27418
Office
Unavailable
Facility
$788.67
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 27418
Office
Unavailable
Facility
$792.31
No comparable office rate is available.
Salinas
California · 27418
Office
Unavailable
Facility
$789.18
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 27418
Office
Unavailable
Facility
$800.72
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 27418
Office
Unavailable
Facility
$885.34
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 27418
Office
Unavailable
Facility
$882.78
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 27418
Office
Unavailable
Facility
$906.74
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 27418
Office
Unavailable
Facility
$896.25
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 27418
Office
Unavailable
Facility
$777.69
No comparable office rate is available.
Santa Cruz-Watsonville
California · 27418
Office
Unavailable
Facility
$802.76
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 27418
Office
Unavailable
Facility
$790.22
No comparable office rate is available.
Santa Rosa-Petaluma
California · 27418
Office
Unavailable
Facility
$810.19
No comparable office rate is available.
Stockton
California · 27418
Office
Unavailable
Facility
$764.36
No comparable office rate is available.
Vallejo
California · 27418
Office
Unavailable
Facility
$844.74
No comparable office rate is available.
Visalia
California · 27418
Office
Unavailable
Facility
$764.36
No comparable office rate is available.
Yuba City
California · 27418
Office
Unavailable
Facility
$764.36
No comparable office rate is available.
Dc + Md/Va Suburbs
District of Columbia · 27418
Office
Unavailable
Facility
$847.31
No comparable office rate is available.
Miami
Florida · 27418
Office
Unavailable
Facility
$891.34
No comparable office rate is available.
Chicago
Illinois · 27418
Office
Unavailable
Facility
$865.16
No comparable office rate is available.
Manhattan
New York · 27418
Office
Unavailable
Facility
$881.84
No comparable office rate is available.
Alaska*
Alaska · 27418
Office
Unavailable
Facility
$938.35
No comparable office rate is available.
Alabama
Alabama · 27418
Office
Unavailable
Facility
$691.70
No comparable office rate is available.
Arkansas
Arkansas · 27418
Office
Unavailable
Facility
$682.90
No comparable office rate is available.
Arizona
Arizona · 27418
Office
Unavailable
Facility
$742.73
No comparable office rate is available.
Colorado
Colorado · 27418
Office
Unavailable
Facility
$771.05
No comparable office rate is available.
Connecticut
Connecticut · 27418
Office
Unavailable
Facility
$810.48
No comparable office rate is available.
Delaware
Delaware · 27418
Office
Unavailable
Facility
$753.76
No comparable office rate is available.
Fort Lauderdale
Florida · 27418
Office
Unavailable
Facility
$828.23
No comparable office rate is available.
Rest Of Florida
Florida · 27418
Office
Unavailable
Facility
$787.54
No comparable office rate is available.
Atlanta
Georgia · 27418
Office
Unavailable
Facility
$784.48
No comparable office rate is available.
Rest Of Georgia
Georgia · 27418
Office
Unavailable
Facility
$744.23
No comparable office rate is available.
Hawaii, Guam
Hawaii · 27418
Office
Unavailable
Facility
$773.90
No comparable office rate is available.
Iowa
Iowa · 27418
Office
Unavailable
Facility
$691.35
No comparable office rate is available.
Idaho
Idaho · 27418
Office
Unavailable
Facility
$698.63
No comparable office rate is available.
East St. Louis
Illinois · 27418
Office
Unavailable
Facility
$814.96
No comparable office rate is available.
Rest Of Illinois
Illinois · 27418
Office
Unavailable
Facility
$778.74
No comparable office rate is available.
Suburban Chicago
Illinois · 27418
Office
Unavailable
Facility
$832.50
No comparable office rate is available.
Indiana
Indiana · 27418
Office
Unavailable
Facility
$701.78
No comparable office rate is available.
Kansas
Kansas · 27418
Office
Unavailable
Facility
$696.01
No comparable office rate is available.
Kentucky
Kentucky · 27418
Office
Unavailable
Facility
$722.39
No comparable office rate is available.
New Orleans
Louisiana · 27418
Office
Unavailable
Facility
$755.19
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 27418
Office
Unavailable
Facility
$724.39
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 27418
Office
Unavailable
Facility
$830.53
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 27418
Office
Unavailable
Facility
$770.36
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 27418
Office
Unavailable
Facility
$809.77
No comparable office rate is available.
Rest Of Maryland
Maryland · 27418
Office
Unavailable
Facility
$764.52
No comparable office rate is available.
Rest Of Maine
Maine · 27418
Office
Unavailable
Facility
$709.88
No comparable office rate is available.
Southern Maine
Maine · 27418
Office
Unavailable
Facility
$732.57
No comparable office rate is available.
Detroit
Michigan · 27418
Office
Unavailable
Facility
$804.15
No comparable office rate is available.
Rest Of Michigan
Michigan · 27418
Office
Unavailable
Facility
$745.98
No comparable office rate is available.
Minnesota
Minnesota · 27418
Office
Unavailable
Facility
$719.06
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 27418
Office
Unavailable
Facility
$742.57
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 27418
Office
Unavailable
Facility
$748.48
No comparable office rate is available.
Rest Of Missouri
Missouri · 27418
Office
Unavailable
Facility
$718.47
No comparable office rate is available.
Mississippi
Mississippi · 27418
Office
Unavailable
Facility
$700.42
No comparable office rate is available.
Montana**
Montana · 27418
Office
Unavailable
Facility
$763.06
No comparable office rate is available.
North Carolina
North Carolina · 27418
Office
Unavailable
Facility
$715.19
No comparable office rate is available.
North Dakota**
North Dakota · 27418
Office
Unavailable
Facility
$718.37
No comparable office rate is available.
Nebraska
Nebraska · 27418
Office
Unavailable
Facility
$692.39
No comparable office rate is available.
New Hampshire
New Hampshire · 27418
Office
Unavailable
Facility
$766.48
No comparable office rate is available.
Northern Nj
New Jersey · 27418
Office
Unavailable
Facility
$841.74
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 27418
Office
Unavailable
Facility
$814.16
No comparable office rate is available.
New Mexico
New Mexico · 27418
Office
Unavailable
Facility
$752.66
No comparable office rate is available.
Nevada**
Nevada · 27418
Office
Unavailable
Facility
$750.91
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 27418
Office
Unavailable
Facility
$910.66
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 27418
Office
Unavailable
Facility
$825.51
No comparable office rate is available.
Queens
New York · 27418
Office
Unavailable
Facility
$877.17
No comparable office rate is available.
Rest Of New York
New York · 27418
Office
Unavailable
Facility
$725.29
No comparable office rate is available.
Ohio
Ohio · 27418
Office
Unavailable
Facility
$736.85
No comparable office rate is available.
Oklahoma
Oklahoma · 27418
Office
Unavailable
Facility
$713.21
No comparable office rate is available.
Portland
Oregon · 27418
Office
Unavailable
Facility
$784.34
No comparable office rate is available.
Rest Of Oregon
Oregon · 27418
Office
Unavailable
Facility
$739.55
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 27418
Office
Unavailable
Facility
$797.29
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 27418
Office
Unavailable
Facility
$733.64
No comparable office rate is available.
Puerto Rico
Puerto Rico · 27418
Office
Unavailable
Facility
$765.49
No comparable office rate is available.
Rhode Island
Rhode Island · 27418
Office
Unavailable
Facility
$772.46
No comparable office rate is available.
South Carolina
South Carolina · 27418
Office
Unavailable
Facility
$728.33
No comparable office rate is available.
South Dakota**
South Dakota · 27418
Office
Unavailable
Facility
$713.09
No comparable office rate is available.
Tennessee
Tennessee · 27418
Office
Unavailable
Facility
$700.05
No comparable office rate is available.
Austin
Texas · 27418
Office
Unavailable
Facility
$773.34
No comparable office rate is available.
Beaumont
Texas · 27418
Office
Unavailable
Facility
$729.95
No comparable office rate is available.
Brazoria
Texas · 27418
Office
Unavailable
Facility
$746.84
No comparable office rate is available.
Dallas
Texas · 27418
Office
Unavailable
Facility
$754.65
No comparable office rate is available.
Fort Worth
Texas · 27418
Office
Unavailable
Facility
$752.53
No comparable office rate is available.
Galveston
Texas · 27418
Office
Unavailable
Facility
$751.08
No comparable office rate is available.
Houston
Texas · 27418
Office
Unavailable
Facility
$792.45
No comparable office rate is available.
Rest Of Texas
Texas · 27418
Office
Unavailable
Facility
$740.08
No comparable office rate is available.
Utah
Utah · 27418
Office
Unavailable
Facility
$736.91
No comparable office rate is available.
Virginia
Virginia · 27418
Office
Unavailable
Facility
$735.75
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 27418
Office
Unavailable
Facility
$765.49
No comparable office rate is available.
Vermont
Vermont · 27418
Office
Unavailable
Facility
$722.82
No comparable office rate is available.
Rest Of Washington
Washington · 27418
Office
Unavailable
Facility
$766.51
No comparable office rate is available.
Seattle (King Cnty)
Washington · 27418
Office
Unavailable
Facility
$838.65
No comparable office rate is available.
Wisconsin
Wisconsin · 27418
Office
Unavailable
Facility
$697.96
No comparable office rate is available.
West Virginia
West Virginia · 27418
Office
Unavailable
Facility
$755.14
No comparable office rate is available.
Wyoming**
Wyoming · 27418
Office
Unavailable
Facility
$743.58
No comparable office rate is available.
See how rates vary across the country
27418 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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 all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Modesto is a Medicare payment area. Our Census mapping connects it to 33 cities and communities in California, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 27418 in Modesto. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$840.80
$764.36 × 110% = $840.80
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 27418 in Modesto.
PPRRVU2026_Oct_nonQPP.csv
2,882
- Code
- 27418
- Physician work
- 11.31
- Practice expense
- 9.28
- Malpractice
- 2.26
GPCI2026.csv
16
- Locality
- Modesto
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 11.31 | × 1.017 | 11.5023 |
| Practice expense | 9.28 | × 1.096 | 10.1709 |
| Malpractice | 2.26 | × 0.536 | 1.2114 |
| Total RVUs | 22.8845 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Modesto$764.36
Open 27418 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 11.31 | 1.017 |
| Practice expense | 9.28 | 1.096 |
| Malpractice | 2.26 | 0.536 |
(11.31 × 1.017 + 9.28 × 1.096 + 2.26 × 0.536) × $33.4009 = $764.36
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
27418 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
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
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $764.36 | RVU26D |
| 2026-07-01 | Not available in this setting | $764.36 | RVU26C |
| 2026-04-01 | Not available in this setting | $764.36 | RVU26B |
| 2026-01-01 | Not available in this setting | $764.36 | RVU26A |
| 2025-10-01 | Not available in this setting | $816.80 | RVU25D |
| 2025-07-01 | Not available in this setting | $816.80 | RVU25C |
| 2025-04-01 | Not available in this setting | $816.80 | RVU25B |
| 2025-01-01 | Not available in this setting | $816.80 | RVU25A |
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
2,87927412,,Autochondrocyte implant knee,A,,24.12,15.50,NA,15.50,,5.13,44.75,44.75,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,88027415,,Osteochondral knee allograft,A,,19.50,14.03,NA,14.03,,4.15,37.68,37.68,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,88127416,,Osteochondral knee autograft,A,,13.81,10.27,NA,10.27,,2.94,27.02,27.02,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,88227418,,Repair degenerated kneecap,A,,11.31,9.28,NA,9.28,,2.26,22.85,22.85,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,88327420,,Revision of unstable kneecap,A,,10.00,8.98,NA,8.98,,2.13,21.11,21.11,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,88427422,,Revision of unstable kneecap,A,,9.95,8.89,NA,8.89,,2.08,20.92,20.92,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,88527424,,Revision/removal of kneecap,A,,9.98,8.97,NA,8.97,,2.13,21.08,21.08,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1301182,CA,18,LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY),1.041,1.183,0.664
1401112,CA,58,MADERA,1.017,1.096,0.536
1501112,CA,59,MERCED,1.017,1.096,0.536
1601112,CA,60,MODESTO,1.017,1.096,0.536
1701112,CA,51,NAPA,1.063,1.318,0.508
1801182,CA,17,OXNARD-THOUSAND OAKS-VENTURA,1.028,1.182,0.623
1901112,CA,61,REDDING,1.017,1.096,0.536