What this is, in plain language
A surgery that replaces the damaged surfaces of the knee joint with metal and plastic components.
Why a clinician orders it
Severe knee arthritis with pain and loss of function that has not improved with conservative care.
Medical necessity — what insurers usually look at
Insurers typically require imaging confirming joint damage and documentation of conservative treatment (PT, weight management, injections, anti-inflammatories) before approving surgery.
Documentation to ask about
- ✓X-ray or MRI findings
- ✓Conservative treatment tried
- ✓Functional limitations
- ✓BMI / weight history (some plans factor this in)
Questions for your provider
- ?Is the hospital and surgical team in my network?
- ?Has prior auth been received in writing?
- ?Will I be admitted as inpatient or outpatient — and how does that affect what I pay?
Why this code is in our seed set
One of the highest-volume major surgeries in Medicare; included in the CMS Top 200 Ranked by Services and consistently in the top 10 inpatient procedures nationally.
Validated against
- •CMS Top 200 Level I CPT Codes Ranked by Services
- •AAOS Clinical Practice Guideline, Surgical Management of Osteoarthritis of the Knee
- •AMA CPT code 27447 descriptor
Terms you'll see
The insurer is reviewing whether the service is clinically appropriate for your situation.
Some services may need plan approval before they are performed.
Lower-risk care that insurers may want documented before a bigger procedure.