Open arthrodesis of the sacroiliac joint, including bone graft harvest and instrumentation when used

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

• Operative note must explicitly state 'open approach' with direct visualization of the sacroiliac joint — vague language like 'standard approach' triggers audit flags
• Document whether bone graft was obtained and the harvest site (iliac crest, local autograft, allograft), even though graft is bundled
• Specify instrumentation used (screws, plates, rods) by name and configuration; note if pelvic fixation extending beyond the sacrum was performed, supporting 22848 if billed
• Preoperative and postoperative diagnosis must support SI joint pathology (e.g., sacroiliitis, SI joint dysfunction, degenerative sacroiliitis, post-traumatic arthritis) with supporting imaging
• If bilateral, document each side separately with side-specific intraoperative findings; supports modifier 50 or dual line-item billing
• Medical necessity documentation: conservative treatment history, duration, and failure prior to surgical intervention — required by most LCDs covering SI joint procedures

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 7 cited references ↓

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

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

Common denial reasons

The recurring reasons claims for CPT 27280 get rejected.

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

• Wrong code selected: 27279 billed when operative note documents open direct-visualization approach, or 27280 billed for a percutaneous/MIS procedure
• Medical necessity denial: insufficient documentation of failed conservative treatment or imaging that correlates symptoms to the SI joint
• Bone graft or instrumentation billed separately — both are bundled into 27280 and cannot be unbundled without triggering NCCI edits
• Bilateral procedure submitted as two units without modifier 50 or without following payer-specific bilateral billing instructions
• Missing or mismatched ICD-10 diagnosis code that does not support SI joint arthrodesis (e.g., lumbar DX used when SI joint pathology should be specified)
• Add-on code 22848 denied when primary procedure code is missing or when pelvic fixation is not separately documented as extending to non-sacral pelvic structures