Total joint replacement codes: 27130 (total hip arthroplasty), 27447 (total knee arthroplasty). Both include a 90-day global period covering preoperative evaluation, surgery, and postoperative care. Implant devices are billed separately by the facility under HCPCS L-codes (prosthetics), not by the surgeon. Modifier 62 applies when a co-surgeon shares the case; modifier 66 when 3+ surgeons comprise a surgical team. Prior authorization is required by most commercial payers for elective joint replacement.
Bill 27130 for total hip replacement, 27447 for total knee replacement. The surgical code bundles preoperative consultation, the operative procedure, and 90 days of postoperative care. Implant costs are not included in the surgical CPT code and are billed separately at the facility level under HCPCS codes. Do not bill separate E/M visits for routine post-op care during the 90-day period. Modifier 62 reduces payment by 50% when co-surgeon splits care; modifier 66 applies when 3+ surgeons work as a team.
Most commercial payers require prior authorization for elective joint replacement. Medicare covers medically necessary joint replacement without visit limits. Authorization typically requires documentation of conservative treatment failure (PT, injections) and imaging confirming degenerative joint disease. Some payers impose age or BMI restrictions. Verify payer-specific coverage criteria and pre-authorization requirements before scheduling.
Use modifier 62 for co-surgeon when two surgeons share responsibility and split the global period. Each co-surgeon bills 50% of the code value. Modifier 66 applies when 3+ surgeons constitute a surgical team for complex procedures. Do not use both modifiers on the same code. Modifier 24 is used only for unrelated E/M during the global period. Modifier 91 (repeat procedure) is not applicable to joint replacement codes.
Document preoperative diagnosis (osteoarthritis, rheumatoid arthritis, post-traumatic arthritis). Include imaging results confirming joint damage. Document conservative treatment attempted (PT, NSAIDs, injections). Record laterality (left, right). Describe operative findings, implant type/size, and any complications encountered. For post-op documentation: note healing progress, range of motion, weight-bearing status, and functional improvement.
27447 = total knee arthroplasty; 27130 = total hip arthroplasty. Both include 90-day global period (pre-op, surgery, post-op care).
No. Implant costs are billed separately by the facility. Surgeon bills the CPT code; facility bills implant devices separately with HCPCS codes.
Modifier 62 = co-surgeon (2 surgeons splitting responsibility). Modifier 66 = surgical team (3+ surgeons). Use based on actual surgical composition.
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