G0415 Posterior Pelvic Fixation HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS G0415: Open Treatment of Posterior Pelvic Fracture and Internal Fixation

HCPCS Level II code G0415 represents open treatment of posterior pelvic bone fractures and/or dislocations that disrupt the pelvic ring, including internal fixation when performed. This surgical code applies to procedures addressing the ilium, sacroiliac joint, and sacrum for unilateral or bilateral disruptions of pelvic stability. Nationally, management of complex pelvic ring injuries carries significant clinical and cost implications due to the need for operative fixation, perioperative care, and potential for prolonged hospitalization.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical intent and common sites of service, plus guidance on where to expect coverage considerations and billing complexity for hospital-based surgery. The publication highlights relevant benchmarks, common modifiers used in practice (listed separately), and the clinical context for coding decisions, including indications for open fixation of posterior pelvic ring injuries. It also outlines what information is available and notes where input data are not provided. This summary is intended for clinicians, coding professionals, and revenue integrity teams seeking a national perspective on billing and documentation implications for open posterior pelvic fixation.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG0415HCPCS Level IIpelvic fractureopen fixationorthopedic surgerysurgical billinginpatient surgeryambulatory surgical center

Billing Code Overview

HCPCS Level II code G0415 describes the open treatment of posterior pelvic bone fracture and/or dislocation for fracture patterns that disrupt the pelvic ring, unilateral or bilateral. The procedure includes internal fixation when performed and covers involvement of the ilium, sacroiliac joint, and/or sacrum.

Service Type: Open surgical fixation of posterior pelvic ring fractures, including internal fixation when performed.

Typical Site of Service: Inpatient hospital or ambulatory surgical center, depending on patient stability and surgical complexity.

Clinical & Coding Specifications

Clinical Context

A 42-year-old male motor-vehicle collision patient presents to a Level I trauma center with pelvic ring instability and hemodynamic stability after initial resuscitation. Imaging (pelvic X‑ray and CT) demonstrates a displaced posterior pelvic ring fracture involving the ilium and sacroiliac joint with disruption of the pelvic ring. After multidisciplinary evaluation by trauma surgery and orthopedic traumatology, the patient is scheduled for open reduction and internal fixation of the posterior pelvic ring. The clinical workflow includes preoperative clearance, surgical consent, anesthesia evaluation (general anesthesia), intraoperative open reduction of the posterior pelvic bone fracture and internal fixation (plates and screws or iliosacral screws), postoperative radiographic confirmation, pain control and thromboprophylaxis, inpatient monitoring for hemorrhage and neurovascular status, and planned outpatient orthopedic follow-up with physical therapy for weight‑bearing progression. The procedure is billed using G0415 and the operative report documents fracture pattern, fixation devices, estimated blood loss, complications (if any), and laterality for correct modifier assignment.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when intraoperative complexity or additional work substantially exceeds typical for and documented.

HCPCS G0472: Hepatitis C Antibody Screening for High-Risk Individuals

HCPCS-G0305-POST-DISCHARGE-PULMONARY-SURGERY-LVRS-6-DAYS

HCPCS G0305: Post-Discharge Pulmonary Surgery Services After LVRS (≥6 Days)

HCPCS-G8875-BREAST-CANCER-PREOPERATIVE-MINIMALLY-INVASIVE-BIOPSY-DIAGNOSIS

HCPCS G8875: Breast Cancer Diagnosed Preoperatively by Minimally Invasive Biopsy

HCPCS-G0140-PRINCIPAL-ILLNESS-NAVIGATION-PEER-SUPPORT

HCPCS G0140: Principal Illness Navigation, Peer Support (60 min/month)

HCPCS-G8980-MOBILITY-WALKING-MOVING-AROUND-DISCHARGE-ASSESSMENT

HCPCS G8980: Mobility — Walking & Moving Around, Discharge Assessment

HCPCS-G2002-IN-HOME-NEW-PATIENT-POST-DISCHARGE-VISIT-30MIN

HCPCS G2002: Limited 30-Minute In-Home Post-Discharge Visit

HCPCS-G8986-CARRYING-MOVING-HANDLING-OBJECTS-DISCHARGE-FUNCTIONAL-STATUS

HCPCS G8986: Carrying, Moving & Handling Objects Functional Limitation

HCPCS-G9634-QUALITY-OF-LIFE-ASSESSMENT-MULTIPLE-VISITS-STABLE-IMPROVED

HCPCS G9634: Health-Related Quality of Life Assessment, Repeat Visits

HCPCS-G0036-PATIENT-CARE-PARTNER-DECLINE-ASSESSMENT

HCPCS G0036: Patient or Care Partner Decline Assessment

HCPCS-G8868-FIRST-COURSE-ANTI-TNF-THERAPY-INITIATION

HCPCS G8868: First Course Anti-TNF Therapy Initiation

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G0415

Taxonomy Code	Specialty	Notes
`2080S0002X`	Orthopaedic Trauma Surgeon	Primary specialty performing open posterior pelvic fixation.
`2086S0105X`	Orthopedic Surgery	General orthopedic surgeons who manage pelvic fractures in trauma settings.
`207L00000X`	General Surgery	Trauma surgeons who may perform pelvic stabilization in multidisciplinary settings.
`2084P0800X`	Physical Medicine & Rehabilitation	Provides postoperative rehabilitation and nonoperative management coordination.
`208D00000X`	Emergency Medicine	Initial stabilization and triage prior to definitive operative management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S32.80XA`	Unspecified fracture of pelvis, initial encounter for closed fracture	Pelvic ring fractures requiring open reduction and internal fixation often fall under pelvic fracture codes such as this when not further specified.
`S32.49XA`	Fracture of sacrum, initial encounter for closed fracture	Sacral fractures disrupting posterior pelvic ring frequently require posterior open fixation.
`S32.40XA`	Fracture of ilium, initial encounter for closed fracture	Iliac wing fractures involving the posterior pelvic ring are addressed with open treatment and fixation.
`S32.85XA`	Fracture of sacroiliac joint, initial encounter for closed fracture	Disruption of the sacroiliac joint that destabilizes the pelvic ring often necessitates surgical fixation described by `G0415`.
`S32.89XA`	Other fractures of pelvis, initial encounter for closed fracture	Captures other specific posterior pelvic bone fractures requiring operative management when a more precise code is not available.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`22325`	Open treatment of posterior pelvic fracture; includes internal fixation when performed (example code for vertebral/pelvic region procedures)	Sometimes used by surgeons for specific pelvic fixation procedures; verify payer mappings against `G0415`.
`27245`	Open treatment of pelvic ring disruption (including internal fixation, when performed)	Commonly used CPT analogous code for open pelvic ring fixation and may be reported in non-HCPCS contexts; documents surgical approach to pelvic ring.
`20690`	Application of external fixation device (e.g., pelvic external fixator), without fracture management	Performed before or as adjunct to internal fixation for temporary stabilization in unstable pelvis.
`73510`	Radiologic examination, pelvis; 2 or 3 views	Preoperative or postoperative radiography to evaluate alignment and hardware position.
`72192`	Computed tomography, pelvic bones, without contrast, diagnostic	Preoperative CT to delineate fracture pattern and plan fixation.
`99223`	Initial hospital care, typically 70 minutes or more, per day, for the evaluation and management of a patient	Used for initial inpatient evaluation/management on the day of or after surgery for complex trauma patients.

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