G0413 Percutaneous Pelvic Fixation HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS G0413: Percutaneous Fixation of Posterior Pelvic Fracture

HCPCS Level II code G0413 represents percutaneous skeletal fixation of posterior pelvic bone fractures and/or dislocations that disrupt the pelvic ring, including procedures involving the ilium, sacroiliac joint, and sacrum. This operative code is used for unilateral or bilateral fixation of posterior pelvic ring injuries and captures a specialized orthopedic surgical service with significant implications for trauma care, surgical resource utilization, and postoperative rehabilitation needs. Nationally, accurate coding for these complex pelvic procedures affects claims processing, quality measurement, and hospital resource planning.

Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of how G0413 is defined clinically, typical sites of service, and the service type. The publication also summarizes common billing modifiers and payer coverage patterns where available, benchmark considerations, and relevant clinical context for fracture types that disrupt the pelvic ring. Where input data is missing, the text notes "Data not available in the input." The aim is to provide clinicians, billers, and policy analysts with a clear, national-level reference for use of HCPCS Level II code G0413 in operative management of posterior pelvic ring injuries.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG0413HCPCS Level IIpelvic fracturepercutaneous fixationorthopedic surgeryposterior pelvic ringtrauma careambulatory surgeryhospital inpatient

Billing Code Overview

HCPCS Level II code G0413 describes percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation for fracture patterns that disrupt the pelvic ring. The procedure may address injuries to the ilium, sacroiliac joint, and/or sacrum and can be performed for unilateral or bilateral injury patterns.

Service Type: Percutaneous skeletal fixation, orthopedic surgical procedure to stabilize posterior pelvic ring fractures.

Typical Site of Service: Hospital inpatient or outpatient surgical setting, including ambulatory surgery centers, depending on clinical severity and patient stability.

Clinical & Coding Specifications

Clinical Context

A 58-year-old male presents after a high-energy motor vehicle collision with severe pelvic pain, inability to ambulate, and hemodynamic stability after resuscitation. Imaging (pelvic radiographs and CT) demonstrates a posterior pelvic ring injury with sacroiliac joint disruption and comminuted sacral fracture that compromises pelvic ring stability. Orthopaedic trauma evaluates the patient; nonoperative management is deemed insufficient due to instability and risk of prolonged immobility. The patient is taken to the operating room for percutaneous skeletal fixation of the posterior pelvic ring, G0413, under fluoroscopic guidance. The procedure includes closed reduction maneuvers and placement of iliosacral screws across the sacroiliac joint and/or trans-sacral fixation to stabilize sacral and posterior iliac elements. Intraoperative neuromonitoring may be used when indicated. Postoperatively, the patient is admitted for pain control, venous thromboembolism prophylaxis, and physical therapy with weight-bearing restrictions as determined by the surgeon. Typical documentation includes preoperative diagnosis, injury mechanism, detailed operative note describing fixation sites (ilium, sacroiliac joint, sacrum), laterality, implants used, estimated blood loss, and any intraoperative complications. Billing uses G0413 for percutaneous skeletal fixation of posterior pelvic fractures disrupting the pelvic ring, with appropriate modifiers to denote laterality, multiple procedures, or provider/surgical circumstances.

Coding Specifications

Modifier	Description	When to Use

HCPCS G9875: MDPP Nine Core Sessions, Expanded Model

HCPCS-G2012-VIRTUAL-CHECK-IN-ESTABLISHED-PATIENT

HCPCS G2012: Brief Virtual Check-In for Established Patients

HCPCS-G9471-CENTRAL-DXA-NOT-ORDERED-OR-DOCUMENTED

HCPCS G9471: Central DXA Not Ordered or Documented

HCPCS-G0506-CHRONIC-CARE-MANAGEMENT-COMPREHENSIVE-ASSESSMENT-CARE-PLAN

HCPCS G0506: Comprehensive Assessment and Care Planning for Chronic Care

HCPCS-G0310-IMMUNIZATION-COUNSELING-NO-VACCINE-ADMINISTERED

HCPCS G0310: Immunization Counseling When Vaccine Not Administered

HCPCS-G9064-NON-SMALL-CELL-LUNG-CANCER-STAGE-II-NO-EVIDENCE-OF-DISEASE

HCPCS G9064: Non-Small Cell Lung Cancer Disease Status, Stage II

HCPCS-G9414-MENINGOCOCCAL-VACCINE-DOSE-AGE-10-TO-13

HCPCS G9414: Meningococcal Vaccine Dose Given Ages 10–13

HCPCS-G0558-ADVANCED-PRIMARY-CARE-MANAGEMENT

HCPCS G0558: Advanced Primary Care Management for Complex Chronic Patients

HCPCS-G9201-VTE-PROPHYLAXIS-ADMISSION-DAY

HCPCS G9201: Venous Thromboembolism Prophylaxis on Admission Day

HCPCS-G4021-ORTHOPEDIC-SURGERY-MIPS-SPECIALTY-SET

HCPCS G4021: Orthopedic Surgery MIPS Specialty Set

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`2080P0406X`	Orthopaedic Surgery	Primary specialty performing pelvic ring fixation and percutaneous iliosacral screw placement.
`2080S0105X`	Trauma Surgery	Trauma surgeons or orthopaedic traumatologists commonly manage acute pelvic ring disruptions requiring fixation.
`207L00000X`	General Surgery	General surgeons with trauma focus may participate in multi-disciplinary pelvic fracture care, particularly in hemodynamically unstable patients.
`363L00000X`	Anesthesiology	Anesthesiologists provide perioperative anesthesia care and management for complex trauma fixation.
`2086S0121X`	Physical Medicine & Rehabilitation	PM&R physicians involved in postoperative mobilization plans and functional recovery.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S32.51`	Fracture of sacrum, closed	Sacral fractures that disrupt the posterior pelvic ring and often require percutaneous fixation.
`S32.51A`	Fracture of sacrum, initial encounter for closed fracture	Used for initial hospitalization/encounter when fixation is performed during the acute phase.
`S32.511`	Sacral fracture, displacement, closed	Displaced sacral fractures indicating instability and need for operative stabilization.
`S32.509`	Fracture of sacrum, unspecified, closed	When documentation lacks specific sacral fracture detail but posterior pelvic fixation is still indicated.
`S32.44`	Fracture of ilium, closed	Iliac wing fractures that contribute to pelvic ring disruption treated with percutaneous fixation.
`S32.62`	Unspecified disruption of pelvic ring, initial encounter	Pelvic ring disruptions that include posterior elements and justify `G0413` fixation.
`S32.63`	Open disruption of pelvic ring	Open pelvic ring injuries that may require additional soft tissue management in conjunction with skeletal fixation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`22630`	Arthrodesis, posterior or posterolateral technique, single level; lumbar	Used when posterior pelvic fixation is supplemented by lumbar-pelvic fusion constructs in severe sacral fractures involving lumbosacral instability.
`27280`	Open treatment of sacral fracture (external fixation, internal fixation or both)	Physically related procedure for sacral fractures; may be performed when open fixation is required instead of percutaneous technique.
`27244`	Percutaneous skeletal fixation of pelvic or acetabular fracture (separate code for anterior or other pelvic elements)	Commonly performed for additional pelvic ring stabilization; may be billed when fixation of pelvic elements other than posterior ring is performed.
`73510`	Radiologic examination, hip, unilateral, 2 views	Preoperative or intraoperative imaging studies that support diagnosis and localization; useful adjunct but billed separately by radiology.
`77002`	Fluoroscopic guidance for needle placement (limited)	Represents image guidance services provided during percutaneous fixation; used when fluoroscopy guidance is reported by the imaging provider.

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