Fusion · Spine

Percutaneous arthrodesis of the sacroiliac joint performed under image guidance, with placement of intra-articular implant(s) — such as bone allograft or a synthetic device — without transfixing the joint.

Verified May 8, 2026 · 9 sources ↓

Medicare: $13,754.82
Total RVUs: 411.81
Global, days: 90
Region: Spine

Drawn from CMSNimblercmAAPCPrnewswire

Documentation requirements

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

Source · Editorial brief grounded in 9 cited references ↓

Operative note must confirm the device was placed within the SI joint space and did not transfix (pass through ilium, across joint, into sacrum)
Image guidance modality used (fluoroscopy, CT) and that it was performed intraoperatively
Implant type documented by name — bone allograft, synthetic device, or trade name — as placed intra-articularly
Pre-operative diagnosis supported by clinical evaluation, imaging, and conservative treatment failure per applicable LCD criteria (e.g., L39802)
Laterality documented: left SI joint, right SI joint, or bilateral with separate entries if staged
Approach and patient positioning noted; audit teams flag notes that omit percutaneous access detail

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 50 Bilateral procedure 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 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 9 cited references ↓

CPT 27278 covers minimally invasive SI joint fusion in which the implant is placed directly into the joint space under image guidance and does not pass through the ilium into the sacrum. That last point — no transfixation — is the defining feature separating 27278 from 27279. If the device crosses the full joint and anchors into the sacrum, use 27279 instead. Image guidance is bundled into 27278; do not bill a separate fluoroscopy or CT guidance code on the same claim.

The code carries a 90-day global period. All routine post-op visits, wound checks, and related E&M services through day 90 are included in the surgical payment. Unrelated problems seen during that window require modifier 24 on the E&M. A new, unrelated procedure in the global period requires modifier 79.

For hybrid devices that combine intra-articular and transfixing components, there is no officially endorsed dual-code pathway. NASS recommends unlisted spine code 22899 for hybrid techniques. Cigna Policy #0303 lists the hybrid approach as experimental/investigational. An NCCI edit bundles 27278 into 27279 when both are submitted together — the column-one code (27279) will pay and 27278 will deny. Confirm carrier-specific guidance before billing any hybrid procedure.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	7.66
Practice expense RVU	403.3
Malpractice RVU	0.85
Total RVU	411.81
Medicare national rate	$13,754.82
Global period	90 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	$13,754.82
HOPD (APC 5116) Hospital outpatient department	$17,913.59
ASC (PI J8) Ambulatory surgical center (freestanding)	$15,047.71

Common denial reasons

The recurring reasons claims for CPT 27278 get rejected.

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

Transfixing device used intraoperatively but 27278 billed — payer or NCCI edit downcodes or denies in favor of 27279
Separate image guidance code billed alongside 27278 — guidance is bundled and will deny
LCD medical necessity criteria not met: inadequate documentation of conservative treatment failure prior to fusion
Hybrid device procedure billed as 27278 or dual-coded 27278 + 27279 — NCCI edit bundles 27278 into 27279; hybrid techniques may trigger experimental/investigational denial under certain payer policies
Routine post-op E&M billed without modifier 24 during the 90-day global period and denied as included in global
Missing laterality modifier when bilateral procedures performed, causing claim rejection or edit

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 9 cited references ↓

01What is the key difference between CPT 27278 and CPT 27279?

27278 is for intra-articular placement only — the implant sits within the joint and does not transfix it. 27279 is for procedures where the fixation device passes through the ilium, crosses the SI joint, and terminates in the sacrum. The operative note must make this distinction explicit.

02Can I bill a separate image guidance code with 27278?

No. Image guidance is bundled into 27278's descriptor. Billing fluoroscopy, CT guidance, or any separate radiologic supervision code on the same claim will result in a denial under NCCI bundling rules.

03How do I code a hybrid SI joint device that uses both intra-articular and transfixing components?

There is no officially endorsed dual-code pathway. NASS recommends unlisted code 22899. Cigna classifies hybrid techniques as experimental/investigational under Policy #0303. An NCCI edit also bundles 27278 into 27279 if both are submitted together. Confirm your carrier's policy before submitting.

04What modifiers apply if I perform bilateral SI joint fusions at the same session?

Append LT and RT to separate line items, or use modifier 50 per payer preference. Document each side independently in the operative report. Confirm bilateral payment policy with the specific payer — some require separate claims.

05What does the 90-day global period cover for 27278?

All routine post-op visits, wound checks, and related E&M services for 90 days are included in the surgical payment. Use modifier 24 for unrelated E&M visits in that window. A new unrelated surgical procedure requires modifier 79.

06Is 27278 covered by Medicare, and are there LCD requirements?

Yes. CMS LCD L39802 governs Medicare coverage for minimally invasive SI joint arthrodesis. Coverage requires documented conservative treatment failure and specific clinical criteria. Coding compliance with the LCD is required for reimbursement from Medicare Administrative Contractors.

07Can I report a pre-operative E&M on the same day as 27278?

If the E&M drove the decision to perform the procedure that same day, modifier 57 is appropriate on the E&M. Routine pre-op assessment is included in the global and should not be billed separately.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the implant type and placement site (intra-articular, no transfixation), the image guidance modality used, laterality, and the surgeon's explicit statement that the device did not cross into the sacrum. That documentation directly prevents the most common audit flag on 27278 — an operative note that doesn't distinguish the procedure from a transfixing 27279, triggering a post-payment takebacks or NCCI bundling denial.

See how Mira captures CPT 27278 documentation