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

Drawn from AAPCEmblemhealthEmednyCMS

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

22 Increased complexity 50 Bilateral procedure 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

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?

Manipulation under anesthesia beyond local. 27197 is closed treatment without manipulation. 27198 requires that the manipulation be performed under general anesthesia, moderate sedation, or spinal/epidural. Same posterior ring anatomy applies to both; the anesthesia level is the sole code selector between them.

02Can I bill 27198 for a purely anterior pelvic ring fracture?

No. Anterior-only injuries — isolated pubic symphysis or superior/inferior rami fractures with no posterior ring involvement — are reported with an E/M code only. CPT eliminated the old 27193/27194 codes in 2017 specifically to enforce this distinction. Billing 27198 for anterior-only injuries will draw denials on medical necessity review.

03Is 27198 ever billed bilaterally, and how?

The code covers unilateral or bilateral injury within a single code. However, if a payer requires bilateral reporting as two separate lines, append LT and RT. Payer policy varies — some accept modifier 50 on a single line; others require two units. Check payer-specific guidelines before submitting.

04What is the global period, and does it affect post-op visit billing?

27198 carries a 000-day global period. There is no bundled post-op care. Follow-up visits on subsequent dates are billed with the appropriate E/M code — no modifier 24 needed since the global doesn't extend beyond the day of service.

05Can I separately bill for fluoroscopy used to confirm reduction?

Imaging guidance is not bundled into 27198 by the code descriptor, but verify current NCCI PTP edits before billing a radiology guidance code on the same date. Document the clinical necessity for any separately reported imaging in the procedure note.

06Were codes 27193 and 27194 replaced by 27197 and 27198?

Yes. CMS and AMA deleted 27193 and 27194 effective January 1, 2017, and replaced them with 27197 and 27198. The new codes require posterior ring involvement; anterior-only fractures dropped to E/M-only reporting. Claims submitted with the old codes after that date will be rejected as invalid.

Sources & references

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

Mira 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