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CPT 27280: Open Sacroiliac Joint Fusion with Autograft and Instrumentation
CPT code 27280 represents an open sacroiliac joint fusion procedure that uses autologous bone grafting and may include internal fixation. This code captures a definitive surgical approach for patients with sacroiliac joint pain or instability and is relevant for national surgical practice patterns, payer coverage decisions, and hospital service-line planning. Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise overview of the clinical intent and typical care setting for the procedure; a summary of which payers are addressed; and what to expect in benchmarking and policy review sections, including common billing considerations and documentation elements relevant to coverage determinations. The publication highlights clinical context around indications for fusion, typical perioperative setting, and elements that influence coding and reimbursement. Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes will be noted where applicable in detailed sections. This material is written for a national audience interested in coding accuracy, payer policy alignment, and operational implications for surgical services involving sacroiliac joint arthrodesis.
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Billing Code Overview
CPT code 27280 describes an open surgical procedure to immobilize the sacroiliac joint by inducing bone formation across the joint, commonly called sacroiliac joint arthrodesis with bone grafting. The code specifically includes harvest of autologous bone graft from the patient and the use of instrumentation when performed.
Service type: Surgical — open sacroiliac joint fusion with autograft and possible instrumentation.
Typical site of service: Inpatient or outpatient hospital operating room or ambulatory surgery center, depending on clinical complexity and payer rules.
National Reimbursement Benchmarks
Commercial averages exceed Medicare: Blue Cross Blue Shield, Cigna, UnitedHealth Group, Aetna and BUCA show mean commercial allowances well above Medicare’s mean of $1,293.10, with BUCA’s mean at $4,330.90 more than three times Medicare. Blue Cross Blue Shield and BUCA sit at particularly high commercial means relative to Medicare, illustrating substantial premium in negotiated commercial markets versus the Medicare baseline.
Dispersion varies notably: compute P75–P25 ranges to compare tightness. Aetna’s range is $1,187.00, Cigna’s is $1,482.60, UnitedHealth Group’s is $1,563.20, BUCA’s is $4,046.30, and Blue Cross Blue Shield’s is $6,040.40. Medicare is tightest with a P75–P25 of $116.00. Blue Cross Blue Shield and BUCA demonstrate the widest dispersion, while Medicare is the most compressed.