CPT 27280: Open Sacroiliac Joint Fusion with Autograft
Medicare pays $1293 and commercial payers pay $4331 on average nationally for this procedure.
CPT code 27280 describes an open surgical sacroiliac joint fusion procedure that surgically immobilizes the sacroiliac joint by inducing bone growth (arthrodesis), typically including harvest of an autologous bone graft and use of instrumentation when performed; service type: open surgical joint fusion/arthrodesis, and typical site of service: inpatient or outpatient hospital or ambulatory surgery center where pelvic and spine orthopedic surgeries are performed.
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 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.