How much does Medicare pay for CPT 27486?

Medicare allowed an average of $1025.80 per service and paid $817.62 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $5298.38, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 27486?

Revision of component of total knee joint prosthesis. It was billed 1,027 times to 988 Medicare beneficiaries by 71 providers in 2024.

Which specialty bills 27486 most?

Orthopedic Surgery, with 818 services from 57 clinicians. Next are Physician Assistant, Nurse Practitioner.

CPT 27486

Revision of component of total knee joint prosthesis

$1025.80Medicare-allowed amount per service, averaged across 1,027 services

Providers submitted

$5298.38

Asking price, not received

Medicare allowed

$1025.80

The fee schedule figure

Medicare paid

$817.62

Balance is patient coinsurance

Providers submitted an average of $5298.38 for this code and Medicare allowed $1025.80 — 5.2× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $817.62 (80%); the rest is the patient’s coinsurance and deductible.

Services: 1,027
Beneficiaries: 988
Providers billing it: 71
Total allowed: $1,053,497

What Medicare pays for CPT 27486

Across 1,027 services billed by 71 providers to 988 beneficiaries, Medicare allowed an average of $1025.80 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 27486

Specialty	Services	Beneficiaries	Avg allowed	Providers
Orthopedic Surgery	818	787	$1242.22	57
Physician Assistant	193	186	$177.50	13
Nurse Practitioner	16	15	$193.72	1

27486 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	141	$1312.87	$957.13	9
North Carolina	112	$743.51	$664.02	7
Florida	96	$1043.64	$897.54	7
Texas	77	$962.19	$856.71	5
Illinois	74	$929.11	$706.43	5
South Carolina	54	$925.61	$764.20	3
Oklahoma	45	$870.39	$772.86	3
Kansas	39	$1213.81	$1034.22	3
Alaska	39	$1220.54	$782.41	3
Georgia	32	$531.68	$540.22	2
Alabama	31	$960.26	$988.94	1
Michigan	26	$901.38	$743.65	2
Ohio	26	$822.44	$1051.15	2
Washington	25	$805.49	$616.77	2
Maryland	23	$1375.09	$1077.30	2
Arkansas	22	$547.96	$592.03	2
Colorado	17	$1229.29	$1097.07	1
Virginia	14	$1283.14	$1097.22	1
Arizona	14	$1189.07	$1052.23	1
Utah	14	$1261.17	$1086.09	1
New Jersey	13	$1493.40	$1094.20	1
Missouri	12	$1319.44	$1072.38	1
Oregon	12	$1310.28	$1125.33	1
Kentucky	12	$724.34	$998.11	1
Iowa	12	$1226.18	$1073.88	1
New York	12	$1521.81	$1094.86	1
Tennessee	11	$879.45	$1099.08	1
Minnesota	11	$1239.70	$1038.59	1
Delaware	11	$1222.58	$1003.12	1

Related codes

27447Replacement of knee joint$1513.55
27446Replacement of knee joint on side of knee$2647.88
27487Revision of thigh and lower leg bone components of total knee joint pr$1314.21
27457Incision or partial removal of upper portion of lower leg bone to repa$286.11

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.