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    OpenPayerBilling CodesArthrodesis Procedures on the Pelvis and Hip JointCPT cpt-27278-sacroiliac-joint-fusion-percutaneous-minimally-invasive
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    CPT 27278: Unilateral Sacroiliac Joint Fusion, Percutaneous

    Medicare pays $14415 and commercial payers pay $6568 on average nationally for this procedure.

    CPT code 27278 describes a unilateral sacroiliac (SI) joint fusion performed via a percutaneous or minimally invasive approach with image guidance, involving placement of one or more intra‑articular implants positioned inside the joint space without penetrating the cortical bone; service type: surgical implantation/minimally invasive orthopedic fusion; typical site of service: outpatient ambulatory surgery center or inpatient hospital operating room depending on clinical setting.

    For related coverage guidance, see recent payer policy updates: Orthopedic Joint Procedures of the Knee for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members, Autologous Chondrocyte Transplantation or Implantation Corporate Medical Policy, Autologous Platelet-Derived Growth Factors (Platelet-Rich Plasma [PRP]).

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    National Reimbursement Benchmarks

    Commercial means vary widely around Medicare: Medicare’s mean of $14,415.20 sits between BUCA’s average commercial mean of $6,567.60 and several commercial payers with higher means such as UnitedHealth Group at $14,364.60 and Cigna at $8,837.10; Medicare’s mean is closest to UnitedHealth Group by value. This places Medicare near the upper-middle of the national spectrum rather than at either extreme, while BUCA reflects a lower commercial-average benchmark.

    Dispersion (P75–P25) highlights different market tightness: Blue Cross Blue Shield’s interquartile spread is $5,759.70, UnitedHealth Group’s spread is $20,552.00, and Cigna’s spread is $15,660.00. Aetna’s spread is $9,171.50 and BUCA’s spread is $9,733.00. The tightest IQR is Blue Cross Blue Shield, and the widest is UnitedHealth Group, indicating Blue Cross Blue Shield prices cluster more tightly around its median while UnitedHealth Group shows the largest middle-50% variability.

    National Payer Mean Reimbursement Rates

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    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 52-year-old ambulatory patient with chronic unilateral low back and buttock pain refractory to conservative care (physical therapy, activity modification, oral analgesics, and at least one image-guided corticosteroid injection) presents for sacroiliac joint evaluation. Imaging with pelvic radiographs and CT or MRI suggests sacroiliac joint degeneration and/or instability correlating with exam and diagnostic SI joint injection providing significant temporary relief. The provider schedules a minimally invasive, unilateral sacroiliac joint fusion using intra-articular implants placed without violating cortical bone under fluoroscopic image guidance.

    Preoperative workflow includes history and physical, documentation of failed conservative therapies, informed consent, preoperative anesthesia evaluation, and perioperative time-out. Intraoperative steps include percutaneous access to the SI joint, placement of intra-articular implant(s) under fluoroscopy, hemostasis, and wound closure. Postoperative workflow includes recovery room monitoring, discharge instructions, activity restrictions, analgesia plan, and outpatient follow-up for wound check and progressive mobilization. The typical site of service is an ambulatory surgery center or hospital outpatient department.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    64483Injection(s), anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve block (single level); lumbar or sacral

    Related Modifiers

    12 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

    Showing 1–10 of 12

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    2084P0800X
    163WA0400X
    164X00000X
    225XP0019X
    1223P0700X
    152WX0102X
    207ZF0201X
    2080T0004X

    Related Payer Policy Updates

    Specialty: Orthopedics/Musculoskeletal1 / 2

    10 rows

    PolicyPayerEffective Date
    Orthopedic Joint Procedures of the Knee for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Membersuniverahealthcare2027-01-01
    Autologous Chondrocyte Transplantation or Implantation Corporate Medical Policybcbsvermont2026-12-01
    Autologous Platelet-Derived Growth Factors (Platelet-Rich Plasma [PRP])Cigna2026-10-15
    Metatarsophalangeal Joint ReplacementCigna2026-10-15
    Shoulder Arthroplasty (Total, Partial, Reverse, Revision and Resurfacing)univerahealthcare2026-10-15
    Hip Arthroplasty (partial and total hip replacement)univerahealthcare2026-10-15
    Artificial Lumbar Intervertebral Disc (Lumbar Total Disc Arthroplasty)univerahealthcare2026-10-15
    Osteochondral Grafting of the Kneeuniverahealthcare2026-10-15
    Lumbar Fusion (arthrodesis) with decompressionuniverahealthcare2026-10-15
    Metal-on-Metal Total Hip Resurfacinguniverahealthcare2026-10-15

    Related Codes

    CPT-27279-SACROILIAC-JOINT-FUSION-PERCUTANEOUS-UNILATERAL

    CPT 27279: Unilateral Minimally Invasive Sacroiliac Joint Fusion

    CPT-27280-SACROILIAC-JOINT-FUSION-OPEN-WITH-AUTOGRAFT

    CPT 27280: Open Sacroiliac Joint Fusion with Autograft

    CPT-27282-PUBIC-SYMPHYSIS-ARTHRODESIS-WITH-AUTOGRAFT-AND-FIXATION

    CPT 27282: Pubic Symphysis Arthrodesis with Autograft and Fixation

    CPT-27284-HIP-ARTHRODESIS-WITH-AUTOGRAFT

    CPT 27284: Hip Arthrodesis with Autograft

    CPT-27286-HIP-IMMOBILIZATION-WITH-GRAFT-AND-SUBTROCHANTERIC-OSTEOTOMY

    CPT 27286: Hip Arthrodesis with Autograft and Subtrochanteric Osteotomy

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Diagnostic or therapeutic SI region injections or facet injections may precede 27278 for diagnostic localization and conservative management.
    20610Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee); without ultrasound guidanceDiagnostic or therapeutic joint injections in the pelvis/SI region may be performed prior to fusion; image guidance often preferred.
    77002Fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection), spine or paraspinous regions; first levelFluoroscopic image guidance is included in 27278 but additional fluoroscopy guidance codes may be reported if separate services are provided.
    63047Laminectomy, facetectomy and foraminotomy (any method), lumbar; single interspaceSpine procedures such as decompression may be performed in combination with SI fusion in patients with multi-level spinal disease.
    22899Unlisted procedure, spine or vertebral columnUsed when an unlisted or novel spinal/pelvic procedure is performed in conjunction with 27278 and no specific code exists; documentation must support the service.
    20930Allograft, morselized, or placement of biologic implant for spine surgeryBone grafting or biologic augmentation may be performed in conjunction with SI fusion depending on surgical technique.