CPT code 27278: SI joint fusion, intra-articular implants2026 Medicare rate & RVUs in Missouri
Reports percutaneous sacroiliac joint arthrodesis using intra-articular implants without a transfixation device, with image guidance included.
Medicare pays $11,895.15–$13,108.29 for 27278 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 27278 covers
A surgeon uses a percutaneous approach to fuse the sacroiliac joint by placing implant(s) within the joint without a transfixation device. The procedure may be considered for selected patients with symptomatic SI joint conditions, such as degenerative joint disease or SI joint dysfunction. Orthopedic and spine surgeons typically perform it in an operating room or other procedural setting, using image guidance to place the implants.
Choose this code when the operative report supports the intra-articular implant technique; a transfixation-device approach is reported with a different code. Image guidance is included. Documentation should identify the treated joint, approach, implant placement, and arthrodesis performed. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 27278 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$11895.15 to $13108.29
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $12,932.47 | $429.12 |
| Metropolitan St. Louis, MO | $13,108.29 | $431.84 |
| Rest of Missouri | $11,895.15 | $417.10 |
How the 27278 rate is calculated
Each of 27278’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 27278
RVUs × geographic indexes × conversion factor
Work7.66
7.66 RVUs× 1.000 GPCI
Practice expense403.30
403.30 RVUs× 1.000 GPCI
Malpractice0.85
0.85 RVUs× 1.000 GPCI
Adjusted RVUs
411.8100
Conversion factor
$33.4009
Medicare rate
$13,754.82
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 27278
27278 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 27278
SI joint fusion, intra-articular implants
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 27278
SI joint fusion, intra-articular implants
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
27278 without 50 · national office
$13,754.82
SI joint fusion, intra-articular implants
27278-50 · Bilateral: 150%
$20,632.23
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
27278 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 27279SI joint fusionTransarticular device placement
- Use 27278 for intra-articular implants without a transfixation device. Use 27279 when the operative technique places a transfixation device across the SI joint.
- 27280SI joint fusionOpen, grafted, instrumented
- 27280 describes open SI joint arthrodesis. This code describes percutaneous arthrodesis with intra-articular implants and no transfixation device.
- 27299Unlisted pelvis/hip procedureCarrier priced
- Use this specific code when the documented technique matches its percutaneous intra-articular implant service. Reserve 27299 for a procedure not described by a specific code.
27278 billing questions
How does this differ from 27279?
This code describes intra-articular implant placement without a transfixation device. Code 27279 is for SI joint arthrodesis with placement of a transfixation device.
Can image guidance be reported separately?
No. Image guidance used for this arthrodesis is included in the service.
How should bilateral SI joint fusion be reported?
Use modifier 50 for a bilateral procedure. CMS pays the bilateral service at 150%.
What documentation supports this code?
The operative report should identify the SI joint treated, the percutaneous approach, arthrodesis, and intra-articular implant placement without a transfixation device.
Is postoperative care included?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
When is assistant-at-surgery payment allowed?
CMS allows assistant-at-surgery payment only when medical necessity is documented.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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