CPT 27447 (total knee arthroplasty) carries 19.11 work RVU in the CY2026 Medicare Physician Fee Schedule (MPFS), the RVU dataset RVUinUSA uses for its calculators. That work RVU figure is the number most orthopedic surgeons see quoted in compensation conversations, but it is only one-third of what CMS actually uses to calculate a Medicare payment, and it is not the same thing as a dollar amount. Understanding the difference between the wRVU used in a compensation formula and the full RVU-to-payment calculation CMS runs is the point of this guide.
What 19.11 Work RVU Actually Represents
Work RVU (wRVU) is a relative measure of physician time, technical skill, mental effort, judgment, and stress associated with a service, as recommended through the AMA/Specialty Society RVS Update Committee (RUC) process and finalized by CMS each year. It does not include the cost of running an operating room, supplies, staff, or malpractice insurance — those are captured separately.
CPT 27447 is a 90-day global period procedure, meaning the wRVU value bundles routine post-operative visits related to the knee replacement into that single code. A surgeon does not bill separately for most follow-up visits within 90 days of surgery, and that bundling is already reflected in the 19.11 figure.
Total knee arthroplasty’s three CY2026 RVU components are:
| Component | CY2026 Value | What it represents |
|---|---|---|
| Work RVU | 19.11 | Physician time, skill, and effort |
| Practice Expense RVU (non-facility) | 11.58 | Overhead when billed in a non-facility setting |
| Practice Expense RVU (facility) | 11.58 | Overhead when billed in a hospital/ASC setting |
| Malpractice RVU | 4.02 | Professional liability cost allocation |
| Total RVU | 34.71 | Sum of all three components |
For most surgical codes, facility PE RVU is lower than non-facility PE RVU because the hospital absorbs overhead costs when the procedure is performed there. CPT 27447 is almost always billed in a facility setting, and CMS’s PE methodology has both settings converging near the same value for this code in the CY2026 file. If you’re pulling this data for modeling, confirm the current year’s split directly through a CPT-specific RVU lookup rather than assuming facility and non-facility PE are always identical — that pattern doesn’t hold for most other codes.
Why Work RVU Alone Doesn’t Tell You the Medicare Payment
Medicare payment is not work RVU multiplied by a flat rate. CMS applies a separate Geographic Practice Cost Index (GPCI) to each of the three components — because labor costs, rents, and malpractice premiums vary by locality — and only then multiplies the total by a conversion factor (CF).
The formula is:
Medicare Payment = [(Work RVU × Work GPCI) + (PE RVU × PE GPCI) + (MP RVU × MP GPCI)] × Conversion Factor
CY2026 introduced a structural change that matters here: for the first time, CMS finalized two separate conversion factors instead of one. Clinicians who are Qualifying Alternative Payment Model (APM) Participants (QPs) are paid using a CF of approximately $33.57, while non-qualifying clinicians — most physicians — use a CF of approximately $33.40. This replaces the single CY2025 CF of $32.35. Any 27447 payment estimate built on a 2025 CF or on the assumption of one universal CF for 2026 will be off by roughly 3%, and QP versus non-QP status changes which of the two CY2026 figures applies.
Illustrative Payment Calculation
Using national, unadjusted CY2026 RVU values for CPT 27447 (34.71 total RVU) with the non-QP conversion factor and a simplified locality where all GPCI factors equal 1.0:
Payment = (19.11 × 1.0 + 11.58 × 1.0 + 4.02 × 1.0) × 33.40
Payment = 34.71 × 33.40
Payment ≈ $1,159
This is an illustrative, GPCI-neutral estimate, not an official CMS payment figure and not what any specific practice will receive. Real-world claims run through locality-specific GPCI values, which push payment up in high-cost metro areas and down in lower-cost localities — sometimes by several hundred dollars for a high-RVU procedure like total knee arthroplasty. Run the actual locality through the GPCI calculator before using a payment number in any financial model, and confirm the current-year conversion factor and QP status before finalizing.
wRVU-Based Compensation Is a Separate Calculation
Many orthopedic groups pay surgeons on a dollars-per-wRVU compensation model, which is contractual and has nothing to do with Medicare’s GPCI-adjusted payment formula. In that model:
Physician Compensation = Work RVU × Negotiated Compensation Rate
Example: if a group’s negotiated rate is $65 per wRVU and a surgeon performs one CPT 27447 case, that single case credits 19.11 wRVU × $65 = $1,242.15 in compensation value — a number set by contract, not by CMS. Compare that to the Medicare payment estimate above (~$1,159 before GPCI, for the whole claim including PE and MP components) and the difference is clear: compensation is a private contractual formula applied only to the work RVU component, while Medicare payment is a public formula applied to all three RVU components after geographic adjustment. Treating these as interchangeable is one of the most common errors in physician compensation modeling — a high dollars-per-wRVU rate says nothing about whether Medicare, or any payer, will actually reimburse the practice enough to cover overhead for that case.
Comparing 27447 Against Other Orthopedic and E/M Codes
Case-mix modeling for an orthopedic surgeon usually blends arthroplasty, arthroscopy, fracture care, and clinic evaluation and management (E/M) work. The table below uses CY2026 national RVU values (non-facility PE shown) for comparison purposes only — always confirm current values through a CPT-specific lookup before using them in a live model, since RVU files are updated annually and sometimes mid-year through correction notices.
| CPT | Procedure | Work RVU | PE RVU | MP RVU | Total RVU |
|---|---|---|---|---|---|
| 27447 | Total knee arthroplasty | 19.11 | 11.58 | 4.02 | 34.71 |
| 29827 | Shoulder arthroscopy, rotator cuff repair | ~15.6 | ~10.8 | ~2.9 | ~29.3 |
| 99214 | Established patient office visit, level 4 | 1.92 | 1.78 | 0.14 | 4.06 |
A single 27447 case generates roughly the same work RVU credit as ten level-4 office visits. That’s useful for understanding why one or two total knee cases a week can carry a clinic’s monthly wRVU target — but it doesn’t tell you whether the surgeon has enough OR block time, referral volume, or implant vendor support to actually get those cases scheduled. RVU value and case access are two different constraints, and a compensation model that only looks at the RVU side will overestimate what’s realistically achievable.
What Changes the Numbers From Year to Year
Three things move independently and all affect the same CPT code:
- Work RVU can change when CMS accepts or rejects a RUC revaluation recommendation. CPT 27447’s work RVU has been stable in recent cycles, but that isn’t guaranteed for every code every year.
- GPCI values are updated on a periodic cycle (not necessarily annually) and reflect local wage and cost data by Medicare locality.
- Conversion factor changes annually based on the statutory update formula, budget neutrality adjustments, and — starting in CY2026 — QP versus non-QP status.
Because all three can shift independently, a payment estimate calculated with CY2025 data does not carry forward accurately into CY2026, even if the work RVU itself didn’t change. Always confirm which RVU year and which conversion factor (QP or non-QP) a comparison is using before drawing conclusions from it.
Using This Data With RVUinUSA Tools
CPT 27447’s RVU components are inputs, not outputs. To turn them into something decision-useful:
- Use the RVU calculator to combine work, PE, and MP RVU into a total RVU figure for a given code and setting.
- Run that total through the GPCI calculator for a specific Medicare locality to get a realistic, geography-adjusted payment estimate rather than a national average.
- Check the orthopedic surgery wRVU benchmarks article if the underlying question is whether an annual wRVU production target is typical for total joint volume.
- Review the physician compensation wRVU benchmarks page if the question is about dollars-per-wRVU rates rather than RVU values themselves.
- If a contract ties a bonus threshold to annual wRVU output that depends heavily on total knee volume, the contract red flags guide covers how OR access, ramp-up periods, and global-period crediting rules can make an RVU-based target unattainable even when the per-case RVU value looks generous.
Where RVU Data Stops and Coding/Payer Judgment Starts
RVU values for CPT 27447 assume the code has already been correctly selected — that the documentation supports a primary total knee arthroplasty rather than a partial or revision procedure, that bilateral or assistant-at-surgery modifiers are applied correctly if relevant, and that the payer’s specific policy for the code has been checked. None of that is determined by the RVU data itself. RVU figures answer “how is this already-coded service valued and paid,” not “which code should be billed.” Coding accuracy, modifier use, and payer-specific coverage rules require separate documentation and compliance review before RVU or payment figures are applied to a real claim or compensation calculation.