Fracture care · Other

G0413

Percutaneous skeletal fixation of a posterior pelvic bone fracture or dislocation involving a ring-disrupting pattern, performed unilaterally or bilaterally, covering the ilium, sacroiliac joint, and/or sacrum.

Verified May 8, 2026 · 8 sources ↓

Medicare
$977.98
Total RVUs
29.28
Global, days
90
Region
Other
Drawn from AAPCMedicaidEmblemhealthCMS

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

  • Specify that the fracture pattern disrupts the pelvic ring — not just an isolated anterior injury
  • Identify all posterior structures involved: ilium, sacroiliac joint, and/or sacrum
  • Document percutaneous approach explicitly; open reduction maps to different codes (G0415/27218)
  • State laterality — unilateral or bilateral — in the operative note and on the claim
  • Record fluoroscopic or image guidance used intraoperatively, noting it is integral to the procedure
  • Include fracture classification (e.g., Young-Burgess, Tile) to support medical necessity
  • Document pre-op imaging confirming posterior ring disruption (CT preferred over plain film)

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

G0413 is the HCPCS code Medicare and many Medicaid programs require for percutaneous stabilization of posterior pelvic ring fractures — replacing CPT 27216, which CMS does not recognize. The code covers ring-disrupting fracture patterns involving the ilium, sacroiliac joint, and/or sacrum, and it applies whether the fixation is unilateral or bilateral. North Carolina Medicaid made the formal switch from 27216 to G0413 in June 2018; other state Medicaid programs have followed CMS's lead, but verify payer-by-payer before submitting 27216 to any non-Medicare payer.

The 90-day global period encompasses the operative day, any day-before visit, and all routine post-op management through day 90. Unrelated procedures or new injuries treated during that window require modifier 79. A complication requiring a return to the OR for a related procedure bills under modifier 78. Fluoroscopic guidance used for percutaneous pelvic fixation is generally bundled into the procedure under NCCI policy — do not separately report fluoroscopy unless a distinct additional procedure independently warrants imaging.

Bilateral fixation is reported on a single claim line with modifier 50 for physician billing. ASC claims split bilateral procedures onto two lines using modifiers LT and RT per CMS NCCI Medicare 2026 policy. Anterior-only ring injuries (pubic symphysis, superior/inferior rami) do not qualify for G0413 — those are reported with an appropriate E/M code when treated without posterior fixation.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU15.34
Practice expense RVU10.68
Malpractice RVU3.26
Total RVU29.28
Medicare national rate$977.98
Global period90 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

SettingMedicare rate (national)
Office (PFS non-facility)
Procedure performed in physician's office
$977.98
HOPD (APC 5114)
Hospital outpatient department
$7,413.38
ASC (PI J8)
Ambulatory surgical center (freestanding)
$4,653.96

Common denial reasons

The recurring reasons claims for CPT G0413 get rejected.

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

  • Submitting CPT 27216 to Medicare or a Medicaid program that has adopted G0413 — CMS does not recognize 27216
  • Billing G0413 for an anterior-only pelvic ring injury; those require an E/M code, not a fixation code
  • Separately reporting fluoroscopy or image guidance bundled into the percutaneous fixation under NCCI policy
  • Missing or vague laterality documentation when bilateral fixation was performed
  • Failing to append modifier 50 for bilateral procedures on physician claims, causing underpayment or rejection
  • Billing an E/M during the 90-day global period without modifier 24 for a clearly unrelated diagnosis

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01Why does Medicare require G0413 instead of CPT 27216?
CMS established G0413 as the required HCPCS code for this procedure and does not price CPT 27216 on the Medicare Physician Fee Schedule. Claims submitted with 27216 to Medicare will be denied or returned. Many state Medicaid programs — including North Carolina since June 2018 — have adopted G0413 for the same reason.
02Does G0413 cover bilateral fixation, or do I need two codes?
G0413 covers both unilateral and bilateral fixation in a single code. For physician billing, report one line with modifier 50 for bilateral. For ASC claims, CMS NCCI 2026 policy requires two claim lines — one with modifier LT, one with RT — each with one unit of service.
03Can I report fluoroscopy separately when performing G0413?
No. Under NCCI policy, radiologic guidance integral to the percutaneous fixation procedure is bundled and cannot be separately reported. Only bill a separate imaging code if a distinct additional procedure at a different anatomic site independently required its own guidance.
04What is the global period for G0413, and what does it include?
G0413 carries a 90-day global period covering the day-before visit, the operative day, and all routine post-op management through day 90. E/M visits related to the fracture care within that window are included. Use modifier 24 for E/M visits clearly unrelated to the pelvic fixation, and modifier 79 for unrelated procedures.
05My patient has both anterior and posterior ring involvement. Does G0413 cover the anterior component too?
G0413 addresses posterior ring fixation. The code's scope includes associated anterior injury as part of the overall ring-disrupting pattern, but if only the anterior ring (pubic symphysis, superior/inferior rami) is treated without posterior fixation, use an appropriate E/M code — not G0413 or a fixation code.
06If a complication requires a return to the OR during the 90-day global, how do I bill?
A return to the OR for a complication related to the original pelvic fixation uses modifier 78. An unrelated procedure performed during the global period uses modifier 79. Never invert these — modifier 78 is for related returns; 79 is for unrelated procedures.
07Can G0413 be billed with modifier 22 for unusually complex cases?
Yes, but modifier 22 requires supporting documentation in the operative note — increased surgical time, excessive blood loss, difficult anatomy, or extraordinary complexity beyond the standard procedure. A bare assertion of complexity without specifics will not survive audit.

Sources & references

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

  1. 01
    aapc.com
    https://www.aapc.com/codes/hcpcs-modifiers/G0413
  2. 02
    medicaid.ncdhhs.gov
    https://medicaid.ncdhhs.gov/blog/2018/05/15/billing-percutaneous-repair-pelvic-ring-fractures
  3. 03
    emblemhealth.com
    https://www.emblemhealth.com/providers/claims-corner/coding/pelvic-ring-fractures
  4. 04
    cms.gov
    https://www.cms.gov/files/document/04-chapter4-ncci-medicare-policy-manual-2026-final.pdf
  5. 05
    cms.gov
    https://www.cms.gov/files/document/04-chapter4-ncci-medicaid-policy-manual-2025finalcleanpdf.pdf
  6. 06
    cms.gov
    https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=53322
  7. 07
    aapc.com
    https://www.aapc.com/blog/37663-learn-the-latest-in-pelvic-fracture-coding/
  8. 08CMS Physician Fee Schedule 2026

Mira AI Scribe

Mira's AI scribe captures the fracture classification, specific posterior structures fixed (ilium, sacroiliac joint, sacrum), approach (percutaneous versus open), laterality, and image guidance used — the four elements auditors most commonly flag as missing. That documentation locks in G0413 over the lower-paying alternatives and prevents downcoding to an E/M when the posterior ring disruption is clearly operative.

See how Mira captures CPT G0413 documentation

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