Closed treatment of a posterior pelvic ring fracture, dislocation, diastasis, or subluxation involving the ilium, sacroiliac joint, and/or sacrum — without manipulation. May include concurrent anterior ring injury.

Verified May 8, 2026 · 5 sources ↓

Medicare: $123.58
Work RVU: 1.49
Global, days: 0
Region: Hip

Drawn from AAPCEmblemhealthOutsourcestrategiesAssetsCMS

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 5 cited references ↓

Identify the specific posterior ring structure(s) involved: ilium, sacroiliac joint, and/or sacrum — not just 'pelvic fracture'
Confirm no surgical incision or manual reduction was performed; document the non-manipulative approach explicitly
Record mechanism of injury (e.g., MVC, fall from height, crush injury) and relevant trauma context
Include imaging findings (X-ray, CT) with fracture pattern, displacement status, and stability assessment
Document the treatment plan: pelvic binder, orthosis, weight-bearing restrictions, or bed rest protocol
If anterior ring injury is also present, document it but confirm posterior involvement to justify 27197 over an E/M code alone

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

25 Significant separate E/M 57 Decision for surgery 76 Repeat, same physician 77 Repeat, another physician 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

27197 covers non-operative management of posterior pelvic ring disruptions — fractures, dislocations, diastasis, or subluxation of the ilium, sacroiliac joint, and/or sacrum — without manual reduction. The key distinction is posterior involvement: if you're treating only an anterior ring fracture or isolated pubic symphysis/rami injury, 27197 does not apply. Bill an appropriate E/M code for anterior-only injuries instead.

27197 replaced the deleted codes 27193 and 27194 as of January 1, 2017. The newer code pairing (27197/27198) added clinical specificity by separating posterior ring injuries from anterior-only injuries and by distinguishing non-manipulative (27197) from manipulative treatment (27198). Manipulation requiring more than local anesthesia — general, moderate sedation, or spinal/epidural — upgrades the service to 27198.

This code carries a 000-day global period, meaning no built-in post-op follow-up is included. Every subsequent encounter, including fracture checks and cast/brace management, must be billed separately. Document the posterior ring structure(s) involved by name, mechanism of injury, imaging findings, and the specific stabilization plan (brace, pelvic binder, bed rest protocol) at each visit to support continued medical necessity.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (1.49) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (3.7) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.49
Practice expense RVU	1.91
Malpractice RVU	0.3
Total RVU	3.7
Medicare national rate	$123.58
Global period	0 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$123.58
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI G2) Ambulatory surgical center (freestanding)	$135.54

Common denial reasons

The recurring reasons claims for CPT 27197 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Billing 27197 for an anterior-only pelvic ring fracture — CPT guidelines require an E/M code for isolated anterior injuries
Missing documentation of posterior ring structure involvement (ilium, SI joint, or sacrum) by anatomic name
Upcoding to 27198 level when no manipulation was performed, or downcoding when manipulation was performed and a higher level of anesthesia was used
Submitting follow-up visits without separate E/M documentation — the 000-day global means each post-fracture visit needs its own billable service
Insufficient imaging documentation to support fracture diagnosis and treatment decision

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Can I bill 27197 for an isolated pubic rami fracture?

No. Isolated anterior ring injuries — pubic symphysis disruption, superior or inferior rami fractures — are not reportable with 27197. Per CPT guidelines effective January 1, 2017, those encounters should be billed with an appropriate E/M code.

02What is the global period for 27197, and how does that affect follow-up billing?

27197 has a 000-day global period. There is no built-in post-op follow-up window. Every subsequent visit — fracture checks, brace adjustments, progress evaluations — must be billed as a separate E/M service with its own documentation.

03When does the service upgrade to 27198 instead of 27197?

When manual reduction is performed and requires more than local anesthesia — meaning general anesthesia, moderate sedation, or spinal/epidural block — bill 27198. If no manipulation was performed, 27197 is correct regardless of anesthesia type used for pain management.

04Do I need modifier 57 or 25 when billing an E/M on the same day as 27197?

If the E/M on the day of service represents the decision for a subsequent surgical procedure, use modifier 57. If it's a separately identifiable evaluation performed the same day as 27197 itself, use modifier 25. Given the 000-day global, modifier 25 is the more common scenario here.

05Is 27197 ever appropriate for sacral fractures without SI joint involvement?

Yes. The code encompasses sacral fractures as a named posterior ring structure, whether or not the SI joint is disrupted. Document the sacral fracture location, imaging confirmation, and treatment plan explicitly in the operative or encounter note.

06Can 27197 be billed with LT or RT modifiers for lateralized injuries?

Yes, when the injury is clearly unilateral — for example, an isolated iliac wing fracture or a unilateral SI joint disruption — LT or RT is appropriate and some payers require it. For bilateral or central sacral injuries, laterality modifiers are not applicable.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures the posterior ring structure(s) by anatomic name (ilium, SI joint, sacrum), confirms no manual reduction or incision was performed, records mechanism of injury, and pulls the imaging interpretation and stabilization plan directly from dictation. This prevents the most common denial trigger — vague 'pelvic fracture' documentation that fails to establish posterior ring involvement required to distinguish 27197 from an E/M-only encounter.

See how Mira captures CPT 27197 documentation