CPT Code 27278:
Medicare payment, settings, and coverage
Payable in the office, ASC, and Hospital Outpatient settings, with an office value that includes the material placed. Medicare coverage varies by Medicare Administrative Contractor (MAC).
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
CPT Code 27278: 2027 national payment
Physician fee schedule
| CPT Code | Code descriptor | Non-QP APM rate · CY2027 | |
|---|---|---|---|
| Facility | Non-Facility | ||
| 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 | $413 | $13,472 |
Facility = HOPD or ASC; Non-Facility = office. National allowable at the non-qualifying APM conversion factor ($32.63 for 2027). Total RVUs: 412.87 non-facility, 12.66 facility. The office amount includes the practice expense of the material placed; in a facility, the facility is paid separately.
Ambulatory Surgery Center Place of Service 24
| CPT Code | Code descriptor | Status indicator | Device offset % | 2027 Medicare unadjusted rate |
|---|---|---|---|---|
| 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 | J8Device-intensive procedure; paid at adjusted rate | 66.64% | $15,794 |
Device offset %: the share of the ASC payment attributed to the device. National amount before geographic adjustment, sequestration, and patient cost sharing. Source: ASC Addendum AA.
Hospital Outpatient Place of Service 22
| CPT Code | Code descriptor | APC | Status indicator | 2027 Medicare unadjusted rate |
|---|---|---|---|---|
| 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 | 5116Level 6 Musculoskeletal Procedure | J1Hospital Part B services paid through a comprehensive APC | $20,022 |
National amount before geographic adjustment, sequestration, and patient cost sharing. Actual payment varies by locality. Source: CMS OPPS Addendum B.
Device and revenue codes Facility claims
| HCPCS code | Description | OPPS status indicator |
|---|---|---|
| C1889 | Implantable/insertable device for device-intensive procedure, not otherwise classified | NItems and services packaged into APC rate. No separate payment under Original Medicare (commercial payer contracts may vary). |
| C1776 | Joint device (implantable) | |
| L8699 | Prosthetic implant, not otherwise specified |
| Revenue code | Description |
|---|---|
| 0490 | Ambulatory Surgical Center |
| 0360 | Hospital Operating Room Services |
| 0278 | Medical Surgical Supplies/Other Implants |
Device codes are reported with the procedure so the implant's cost is captured on the claim. CMS uses this cost data when setting future APC rates and device offsets. Providers should report the codes that most accurately describe the items and services provided.
Coverage for CPT code 27278 varies by MAC
Medicare coverage for CPT code 27278 varies by Medicare Administrative Contractor (MAC). Wellpoint Federal (formerly NGS), WPS, First Coast, and Novitas do not currently have LCDs explicitly restricting coverage of CPT 27278. In these jurisdictions, coverage is determined based on applicable Medicare requirements and individual claim review. Noridian, Palmetto, and CGS have established LCDs that consider minimally invasive SI joint fusion without transfixation to be not medically reasonable and necessary, resulting in noncoverage of CPT 27278. Medicare Advantage and commercial plans maintain their own coverage policies. Coverage by state →
What does Medicare pay for CPT Code 27278?
The 2027 national amounts are in the tables above; the office amount accounts for applicable practice expenses, including implant costs. Amounts are before geographic adjustment, sequestration, and patient cost sharing; actual payment varies by locality.
Is CPT Code 27278 covered by Medicare?
Medicare coverage for CPT code 27278 varies by Medicare Administrative Contractor (MAC). Wellpoint Federal, WPS, First Coast, and Novitas do not currently have policies explicitly restricting coverage. Noridian, Palmetto, and CGS have established noncoverage policies for the procedure. Coverage and reimbursement are subject to applicable Medicare requirements and individual claim review.
What is the difference between CPT Code 27278 and CPT Code 27279?
Both describe minimally invasive SI joint arthrodesis, including imaging guidance. CPT code 27278 covers intra-articular structural bone graft, metal and/or synthetic device(s) without cortical piercing; CPT code 27279 covers 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.
Questions about coverage or prior authorization?
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); CY2027 OPPS/ASC rule; LCDs L39810, L39797, L39802; AMA CPT® 2027.