CPT Code 27279:
Medicare payment, settings, and coverage
In the ASC and Hospital Outpatient settings, Medicare covers CPT code 27279 in every jurisdiction. For 2027, CMS established a non-facility (office) payment rate; coverage in the office is not yet known.
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
2027 establishes a non-facility (office) rate for CPT code 27279
Prior to January 1, 2027, CPT code 27279 did not have a non-facility payment rate; in 2026 it had facility payment only. For 2027, CMS adopted the RUC-recommended practice expense inputs for CPT code 27279, creating a national non-facility (office) rate, effective for dates of service on or after January 1, 2027.
Physician fee schedule
| CPT Code | Code descriptor | Non-QP APM rate · CY2027 | |
|---|---|---|---|
| Facility | Non-Facility | ||
| 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 | $652 | $19,441 |
Facility = HOPD or ASC; Non-Facility = office. National allowable at the non-qualifying APM conversion factor ($32.63 for 2027). Total RVUs: 595.79 non-facility, 19.97 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 |
|---|---|---|---|---|
| 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 | J8Device-intensive procedure; paid at adjusted rate | 65.10% | $15,518 |
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 |
|---|---|---|---|---|
| 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 | 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 of CPT code 27279 in the office is not yet known
Payment and coverage are decided separately. A fee schedule states what Medicare pays when a service is covered; it does not indicate coverage. Current Local Coverage Determinations (LCDs) address coverage for CPT code 27279 in a facility but do not address the office setting. MACs typically update policy months after a fee schedule change takes effect. Medicare Advantage and commercial plans apply their own policies. Confirm coverage and prior authorization requirements with each payer before scheduling, and our market access team can help. Coverage by state →
What does Medicare pay for CPT Code 27279?
The 2027 national amounts are in the tables above; amounts are before geographic adjustment, sequestration, and patient cost sharing, and actual payment varies by locality.
Does Medicare cover CPT Code 27279 in the office?
Not yet known. A fee schedule does not indicate coverage. Current LCDs address coverage for CPT code 27279 in a facility but do not address the office setting, and MACs typically update policy months after a fee schedule change takes effect. Confirm coverage and prior authorization requirements with each payer before scheduling.
What is the difference between CPT Code 27278 and CPT Code 27279?
Both describe minimally invasive SI joint arthrodesis, including imaging guidance. 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; CPT code 27278 covers intra-articular structural bone graft, metal and/or synthetic device(s) without cortical piercing. 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; Medicare Coverage Database; AMA CPT® 2027.