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    OpenPayerBilling CodesArthrodesis Procedures on the Pelvis and Hip JointCPT cpt-27279-sacroiliac-joint-fusion-percutaneous-unilateral
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    CPT 27279: Unilateral Minimally Invasive Sacroiliac Joint Fusion

    Medicare pays $770 and commercial payers pay $4110 on average nationally for this procedure.

    CPT code 27279 describes a unilateral sacroiliac (SI) joint fusion performed via a percutaneous or minimally invasive approach, in which the provider places transarticular implants that cross the joint and pierce the cortical bone of the ilium and sacrum and/or places intra‑articular implants with at least one implant piercing cortical bone; service type: minimally invasive spine/pelvic surgical fusion; typical site of service: hospital outpatient department or ambulatory surgery center.

    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

    Medicare’s mean rate for CPT 27279 sits at $769.90, which is substantially below the BUCA average commercial mean of $4,109.90. That gap of $3,340.00 highlights a wide separation between government and average commercial reimbursements, with BUCA positioned well above Medicare in absolute dollars per claim.

    Dispersion measured as the interquartile range (P75–P25) varies notably across payers: Blue Cross Blue Shield shows the widest IQR at $6,371.90, followed by UnitedHealth Group at $989.00 and Aetna at $505.00. Cigna’s IQR is $890.00 and BUCA’s IQR is $4, - wait — correcting: BUCA’s P75 $5,631.60 minus P25 $1,646.60 equals $3,985.00. Thus the tightest spread is Aetna ($505.00) and the largest spread is Blue Cross Blue Shield ($6,371.90), indicating substantial variability in commercial contract levels.

    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 patient presents with chronic unilateral sacroiliac (SI) joint pain refractory to conservative care including physical therapy, activity modification, NSAIDs, and image-guided SI joint injections. Pain is localized to the posterior superior iliac region, reproduces with provocative SI maneuvers, and diagnostic SI joint block provided significant temporary relief. After multidisciplinary evaluation and imaging (CT and/or MRI showing degenerative changes or joint disruption), the patient is scheduled for a unilateral minimally invasive sacroiliac joint fusion using percutaneous transarticular and/or intra-articular implants (CPT 27279).

    The typical clinical workflow includes preoperative evaluation and optimization, informed consent discussing risks/benefits and implant specifics, preoperative imaging review, intraoperative fluoroscopic or CT guidance for implant placement across the joint with cortical bone purchase of ilium and sacrum, intraoperative neuromonitoring as indicated, wound closure and recovery in an ambulatory surgery center or hospital outpatient setting, and postoperative pain control with staged rehabilitation. Follow-up includes wound check, radiographic confirmation of hardware position, progressive activity advancement, and monitoring for union and symptom improvement.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    27096Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT); single or multiple injections

    Related Modifiers

    10 rows

    ModifierDescriptionWhen to Use
    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…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    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…
    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…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    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…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…
    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…
    24Modifier 24 denotes an unrelated evaluation and management (E/M) service performed by the same physician or qualified healthcare professional during a postoperative global period. Per CPT guidance,…- Use modifier 24 when you report an evaluation and management (E/M) service performed by the same physician or same-specialty group during a procedure’s postoperative global period that is unrelated…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    2084P0805X
    2084N0400X
    207K00000X
    3418M1130X
    276400000X
    261QP1100X
    111NS0005X
    363LP0200X

    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-27278-SACROILIAC-JOINT-FUSION-PERCUTANEOUS-MINIMALLY-INVASIVE

    CPT 27278: Unilateral Sacroiliac Joint Fusion, Percutaneous

    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.

    Often used as a diagnostic or therapeutic procedure before deciding on CPT 27279; may document temporary pain relief after diagnostic block.

    | 74000 | Radiologic guidance, fluoroscopic; with or without contrast (placeholder example) | Fluoroscopic guidance is commonly used intraoperatively during placement of implants for CPT 27279 (facility/technical component billing may use appropriate fluoroscopy codes). |

    | 22845 | Anterior instrumentation; 3 to 6 vertebral segments | In cases with adjacent spinal fusion or multi-level stabilization, anterior or posterior spinal fusion instrumentation codes like 22845 may be billed for concurrent or staged procedures (code selection depends on spine levels and approach). |

    | 22842 | Posterior segmental instrumentation (e.g., pedicle fixation); 3 to 6 vertebral segments | May be performed in the same patient with complex pelvic or lumbosacral stabilization when clinically indicated alongside CPT 27279. |

    | 27096 | Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance; repeat listing avoided—see above | Included above as primary diagnostic/therapeutic precursor to CPT 27279. |