Closed treatment of posterior pelvic ring fracture(s), dislocation(s), diastasis, or subluxation involving the ilium, sacroiliac joint, and/or sacrum — with or without anterior ring involvement — performed with manipulation under general anesthesia, moderate sedation, or spinal/epidural anesthesia.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $284.24
- Work RVU
- 4.63
- Global, days
- 0
- Region
- Hip
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 6 cited references ↓
- Imaging studies (X-ray, CT) confirming posterior pelvic ring involvement — ilium, sacroiliac joint, or sacrum — with fracture pattern and displacement noted
- Type of anesthesia used (general, moderate sedation, or spinal/epidural) must be explicitly documented — this is the threshold that separates 27198 from 27197
- Operative or procedure note describing the manipulation technique performed and the pre- and post-reduction position of fracture fragments
- Laterality documented — unilateral or bilateral posterior ring involvement — to support modifier assignment if applicable
- Whether anterior pelvic ring injury is also present, even if the code applies with or without it — documents full clinical picture for audit defense
- Any stabilization applied post-manipulation (pelvic binder, orthosis, external device) noted in the procedure record
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 6 cited references ↓
27198 covers closed (non-operative) manipulation of posterior pelvic ring injuries requiring more than local anesthesia. The posterior ring includes the ilium, sacroiliac joint, and sacrum. The code applies whether or not there is a concurrent anterior ring fracture or dislocation involving the pubic symphysis or superior/inferior rami — unilateral or bilateral. The defining requirement is that the manipulation demands general anesthesia, moderate sedation, or spinal/epidural. Without that anesthesia threshold, you're at 27197.
These codes were introduced in 2017 when CPT deleted 27193 and 27194. The restructuring separated posterior ring injuries — typically high-energy, potentially unstable — from anterior-only injuries, which are now reported with an E/M code only. If your patient has a purely anterior ring fracture with no posterior involvement, 27198 does not apply; bill the appropriate E/M instead.
The global period is 000, meaning no bundled pre-op or post-op care. Any follow-up visits on a different date are billed separately. Anesthesia services are reported by the anesthesiologist under the appropriate anesthesia code; the surgeon does not separately bill for the sedation.
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 (4.63) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (8.51) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 4.63 |
| Practice expense RVU | 2.89 |
| Malpractice RVU | 0.99 |
| Total RVU | 8.51 |
| Medicare national rate | $284.24 |
| 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 | $284.24 |
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 27198 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Billing 27198 for an isolated anterior pelvic ring fracture with no posterior involvement — anterior-only injuries are reported with an E/M code, not 27197 or 27198
- Anesthesia level not documented or documented only as 'local' — the code requires general, moderate sedation, or spinal/epidural; missing this drops the claim to 27197 or generates an outright denial
- Use of deleted codes 27193 or 27194, which were removed effective January 1, 2017 — payers will reject these as invalid
- Insufficient imaging documentation to confirm posterior ring involvement, triggering medical necessity denials on audit
- Modifier 50 applied incorrectly on a single-line claim without verifying payer-specific bilateral billing requirements — some payers require two units, others require a single line with modifier 50
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What distinguishes 27198 from 27197?
02Can I bill 27198 for a purely anterior pelvic ring fracture?
03Is 27198 ever billed bilaterally, and how?
04What is the global period, and does it affect post-op visit billing?
05Can I separately bill for fluoroscopy used to confirm reduction?
06Were codes 27193 and 27194 replaced by 27197 and 27198?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01aapc.comhttps://www.aapc.com/codes/cpt-codes/27198
- 02aapc.comhttps://www.aapc.com/codes/cpt_assistant/download_pdf_cpt_assistant/3117
- 03emblemhealth.comhttps://www.emblemhealth.com/providers/claims-corner/coding/pelvic-ring-fractures
- 04emedny.orghttps://www.emedny.org/providermanuals/physician/pdfs/physician%20procedure%20codes%20sect5.pdf
- 05cms.govhttps://www.cms.gov/medicare/coding-billing/ncci-medicaid/medicaid-ncci-edit-files
- 06CMS Physician Fee Schedule 2026
Mira AI Scribe
Mira's AI scribe captures the anesthesia type used during manipulation, the specific posterior pelvic ring structures involved (ilium, SI joint, sacrum), laterality, pre- and post-reduction fracture position, and any anterior ring co-injury — from dictation in real time. This prevents the most common 27198 denial: a note that confirms manipulation but fails to specify the anesthesia level or posterior ring anatomy, leaving auditors unable to distinguish the claim from a lower-reimbursed 27197 or an E/M-only anterior fracture encounter.
See how Mira captures CPT 27198 documentation