G0414

Open surgical treatment of anterior pelvic ring fracture or dislocation, unilateral or bilateral, including internal fixation when performed — covers the pubic symphysis and superior/inferior rami.

Verified May 8, 2026 · 8 sources ↓

Medicare: $924.20
Work RVU: 14.28
Global, days: 90
Region: Other

Drawn from CMSAAPCHcpcsAAOSBedrockbilling

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Operative note must document that the fracture pattern disrupts the pelvic ring — not just that a pelvic fracture is present.
Specify the anatomic structures addressed anteriorly: pubic symphysis, superior ramus, inferior ramus, or combination.
State whether internal fixation was applied and identify implant type (plate, screw, external fixator converted to internal).
Document laterality — unilateral or bilateral — and which side(s) were treated when unilateral.
If G0415 is also billed same-session, the operative note must clearly delineate anterior and posterior ring work as distinct surgical components.
Pre-op imaging (CT preferred) confirming ring-disrupting fracture pattern should be referenced or attached to support medical necessity.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

G0414 is the Medicare HCPCS equivalent of CPT 27217. It covers open treatment of anterior pelvic bone fractures or dislocations that disrupt the pelvic ring — unilateral or bilateral — with internal fixation included when performed. Anatomic scope is the anterior ring: pubic symphysis and superior/inferior rami. CMS created the G041x series when CPT revised the 27215–27218 descriptors to specify 'unilateral'; CMS declined to adopt those revisions and instead crosswalked to G-codes for Medicare billing.

The 90-day global period governs all post-op care. The fracture pattern must be documented as ring-disrupting to justify G0414 over G0412, which applies to fractures that do not disrupt the pelvic ring. For posterior ring involvement — ilium, sacroiliac joint, or sacrum — G0415 (open) or G0413 (percutaneous) applies. When both anterior and posterior rings are addressed in the same operative session, both G0414 and G0415 may be reported together with modifier 51 on the secondary code.

Private payers generally follow CPT, not HCPCS G-codes — submit 27217 to commercial plans unless the payer contract or their fee schedule explicitly references G0414. Confirm payer preference before submission to avoid systematic denials on the entire claim.

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 (14.28) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (27.67) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	14.28
Practice expense RVU	10.35
Malpractice RVU	3.04
Total RVU	27.67
Medicare national rate	$924.20
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	$924.20
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,373.33

Common denial reasons

The recurring reasons claims for CPT G0414 get rejected.

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

Submitting CPT 27217 to Medicare instead of G0414 — Medicare requires the G-code crosswalk.
Missing documentation that the fracture disrupts the pelvic ring, triggering downcoding to G0412.
Billing G0414 and G0415 together without modifier 51, causing the secondary code to process as a duplicate.
Submitting to commercial payers with G0414 when those payers require CPT 27217 per their fee schedule.
Insufficient imaging documentation to establish ring-disruption, prompting medical necessity denials on audit.

Frequently asked questions

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

01When do I use G0414 vs. CPT 27217?

Use G0414 for Medicare claims. CPT 27217 is the corresponding code for commercial payers. They describe the same procedure — CMS crosswalked to G-codes when CPT revised 27215–27218 descriptors and CMS declined to follow. Submitting 27217 to Medicare results in denial.

02Can G0414 and G0415 be billed together in the same operative session?

Yes. When the surgeon addresses both the anterior ring (G0414) and the posterior ring (G0415) in one session, bill both codes. Append modifier 51 to the lower-value code — typically G0415 — to indicate multiple procedures. The operative note must document distinct anterior and posterior ring work.

03Does G0414 cover bilateral procedures, or do I need modifier 50?

The descriptor explicitly reads 'unilateral or bilateral,' so bilateral anterior ring treatment is included within a single G0414 unit. Modifier 50 is not appropriate for Medicare G0414 billing. For private payers using CPT 27217, check payer policy — some follow CPT bilateral rules and accept modifier 50.

04What separates G0414 from G0412?

Ring disruption. G0412 covers open treatment of iliac spine, tuberosity avulsion, or iliac wing fractures that do not disrupt the pelvic ring. G0414 requires documentation that the fracture pattern disrupts ring integrity. If the operative note doesn't state ring disruption, payers will downcode to G0412.

05What modifier applies if the surgeon makes the decision for surgery on the day of or day before the procedure?

Modifier 57 applies to the associated E/M service when the decision for surgery is made within 24 hours of a 90-day global procedure. Append 57 to the E/M code, not to G0414 itself. This allows the E/M to be separately reimbursed despite falling in the preoperative period.

06If the patient returns for a staged posterior ring repair after initial anterior ring fixation, which modifier applies to G0415?

Modifier 58 — staged or related procedure by the same physician during the postoperative period. Document the intent for staged repair in the initial operative note. Modifier 58 resets the global period clock for the G0415 encounter.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the fracture pattern classification (ring-disrupting vs. non-ring-disrupting), specific anterior structures addressed (pubic symphysis, superior ramus, inferior ramus), laterality, internal fixation details including implant type, and whether posterior ring structures were also treated. This prevents the most common audit flag — operative notes that document 'pelvic fracture ORIF' without specifying ring disruption or anatomic location, which triggers downcoding to G0412 or outright medical necessity denials.

See how Mira captures CPT G0414 documentation