G0415

Open surgical treatment of a posterior pelvic fracture or dislocation that disrupts the pelvic ring — unilateral or bilateral — including internal fixation when performed, covering the ilium, sacroiliac joint, and/or sacrum.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,239.17
Total RVUs: 37.1
Global, days: 90
Region: Other

Drawn from AAPCCMSPayerprice

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify that the fracture or dislocation disrupts the pelvic ring — not just the bone involved
Identify the exact posterior structures treated: ilium, sacroiliac joint, sacrum, or combination
State whether the injury is unilateral or bilateral and document each side addressed
Confirm open approach in the operative note — percutaneous fixation codes separately as G0413
Document internal fixation type and placement if fixation was performed during the procedure
Include imaging (CT pelvis) in the record confirming posterior ring disruption pattern
Operative note must reflect the specific fracture classification (e.g., Tile/AO, Young-Burgess) 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 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 74 Discontinued post-anesthesia 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 6 cited references ↓

G0415 is the Medicare HCPCS code for open treatment of posterior pelvic ring disruptions. It covers fractures and dislocations involving the ilium, sacroiliac joint, and sacrum when the injury pattern breaks the structural integrity of the pelvic ring. Internal fixation is included in the code when performed — don't bill hardware application separately. The code applies whether the disruption is unilateral or bilateral.

Medicare requires G0415 (not CPT 27218) for posterior pelvic ring open treatment on Medicare claims. Submitting CPT 27216–27218 to Medicare is a known denial trigger. The G0412–G0415 family maps to distinct injury locations and treatment approaches: G0412 covers fixation of non-ring-disrupting fractures, G0413 covers percutaneous fixation of ring-disrupting fractures, G0414 addresses open treatment of anterior ring injuries (pubic symphysis, rami), and G0415 is specific to open posterior ring treatment.

The 90-day global period means all routine post-op visits, wound checks, and stitch removals through day 90 are bundled. Any same-day E/M that represents the decision to operate needs modifier 57. Staged returns to the OR for related procedures require modifier 58; unplanned returns for related complications use modifier 78; unrelated procedures in the global window use modifier 79.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	20.41
Practice expense RVU	12.26
Malpractice RVU	4.43
Total RVU	37.1
Medicare national rate	$1,239.17
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	$1,239.17
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI G2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT G0415 get rejected.

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

Billing CPT 27218 instead of G0415 for Medicare patients — Medicare requires the G-code series
Missing documentation that the fracture pattern disrupts the pelvic ring, not just the posterior bone
Separately billing internal fixation components already included in G0415
Billing G0415 when a percutaneous approach was used — that maps to G0413
E/M service billed same-day without modifier 57 when the visit was the decision for surgery
Unbundling G0414 and G0415 without adequate documentation that both anterior and posterior ring injuries were each treated through distinct open approaches

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Why does Medicare require G0415 instead of CPT 27218?

Medicare replaced CPT 27215–27218 with the G0412–G0415 family for pelvic ring fracture treatment. Submitting the CPT codes to Medicare will result in denial. Use G0415 for Medicare patients requiring open treatment of posterior ring-disrupting injuries.

02Can G0414 and G0415 be billed together for combined anterior and posterior ring injuries?

Yes, when both anterior and posterior ring injuries are each treated through separate open approaches during the same operative session, G0414 and G0415 may both be reported. Append modifier 51 to the lower-RVU procedure and document each distinct site and approach in the operative note.

03Is internal fixation billed separately when performed with G0415?

No. G0415 includes internal fixation when performed. Do not separately bill implant application codes for fixation of the same posterior pelvic structures.

04What modifier applies if the surgeon decides to operate during a same-day E/M visit?

Use modifier 57 on the E/M code. G0415 carries a 90-day global, making it a major procedure. Modifier 57 allows payment for the E/M when the decision for surgery occurred at that visit — typically the day of or day before surgery.

05How is bilateral posterior pelvic ring injury handled on the claim?

G0415 includes unilateral or bilateral treatment in a single code — the descriptor explicitly covers both. Do not bill two units. If your payer requires laterality, append LT and RT on separate claim lines per ASC billing conventions outlined in the NCCI policy manual.

06What is the global period for G0415 and what does it cover?

G0415 carries a 90-day global period. That covers the day-before visit, the surgery itself, and all routine post-op care through day 90 — wound checks, staple removal, and standard follow-up. Unrelated services in that window require modifier 79; related return-to-OR procedures require modifier 78 or 58 depending on whether the return was planned.

07Does G0415 apply to sacral fractures alone, or only combined injuries?

The code covers fractures of the ilium, sacroiliac joint, and/or sacrum — any one or combination — as long as the fracture pattern disrupts the pelvic ring and is treated with an open approach. A sacral fracture that does not disrupt the ring does not map to G0415.

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 fracture pattern descriptor (ring-disrupting vs. non-ring-disrupting), the specific posterior structures addressed (ilium, sacroiliac joint, sacrum), laterality, surgical approach (open vs. percutaneous), and whether internal fixation was placed. This prevents the most common denial on G0415 claims: insufficient documentation that the injury pattern actually disrupts the pelvic ring, which is the threshold criterion separating G0415 from lower-complexity pelvic fracture codes.

See how Mira captures CPT G0415 documentation