SI joint fusion reimbursement: CPT Codes 27278 and 27279
CPT codes 27278 and 27279 describe minimally invasive SI joint fusion. For 2027, Medicare has payment rates for both codes in the ASC, Hospital Outpatient, and office settings. Coverage is set by each Medicare Administrative Contractor (MAC).
Choose a code, or check coverage in your state
27278
Arthrodesis, sacroiliac joint, percutaneous or minimally invasive, including imaging guidance, unilateral; placement of intra-articular structural bone graft, metal and/or synthetic device(s) without cortical piercing, including use of osteopromotive material and/or obtaining bone graft, when performed.
- Physician fee schedule
- Non-facility (office) payment
- Hospital Outpatient and ASC payment
- APC and status indicator
27279
Arthrodesis, sacroiliac joint, percutaneous or minimally invasive, including imaging guidance, unilateral; placement of transarticular and/or intra-articular device(s) that engage bone with intrinsic fixation (eg, screw[s], flange[s], blade[s]) piercing the lateral cortex of the sacrum and the medial cortex of the ilium (with or without piercing the lateral cortex of the ilium), including use of osteopromotive material and/or obtaining bone graft, when performed.
- Physician fee schedule
- New 2027 non-facility (office) payment
- Hospital Outpatient and ASC payment
- APC and status indicator
Medicare coverage by state
Each Medicare Administrative Contractor's (MAC) coverage policy for both codes.
- MAC map by state
- Coverage status for 27278 and 27279
Payment and coverage are decided separately. A Medicare payment amount does not mean a procedure is covered. Whether a procedure is covered is determined by each Medicare Administrative Contractor's coverage policy and by each health plan. Confirm coverage and prior authorization requirements with each payer before scheduling.
Check coverage by state →Reimbursement information and resources.
Our reimbursement team can answer questions about payer coverage policies, documentation requirements, and the prior authorization process.
reimbursement@painteq.comTreatment decisions should be based solely on each patient’s clinical needs. Providers are responsible for all coding, documentation, and submissions to payers.
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What CPT Codes are used for minimally invasive SI joint fusion?
CPT code 27278 (intra-articular structural bone graft, metal and/or synthetic device(s) without cortical piercing) and CPT code 27279 (transarticular and/or intra-articular device(s) with intrinsic fixation piercing the lateral cortex of the sacrum and the medial cortex of the ilium). Physicians select the CPT code based on the procedure performed and should consult current CPT guidance.
Does a Medicare payment rate mean the procedure is covered?
Payment and coverage are decided separately. A fee schedule states what Medicare pays when a service is covered; it does not indicate coverage. Coverage is determined by each Medicare Administrative Contractor's coverage policy and by each health plan.
Do commercial insurers pay Medicare rates?
Medicare Advantage and commercial plans apply their own policies. Confirm coverage and prior authorization requirements with each payer before scheduling procedures.
Coverage, coding, and payment are determined by individual payers and may vary by geography, plan, and patient. Sources: CMS CY2027 Physician Fee Schedule final rule (CMS-1848-F) and OPPS/ASC rules; Medicare Coverage Database.