How much does Medicare pay for CPT 27280?

Medicare allowed an average of $1317.55 per service and paid $1052.32 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $7452.75, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 27280?

Fusion of sacroiliac joint between spine and pelvis with bone graft, open procedure. It was billed 1,528 times to 1,501 Medicare beneficiaries by 92 providers in 2024.

Which specialty bills 27280 most?

Orthopedic Surgery, with 693 services from 39 clinicians. Next are Neurosurgery, Physician Assistant, Nurse Practitioner.

CPT 27280

Fusion of sacroiliac joint between spine and pelvis with bone graft, open procedure

$1317.55Medicare-allowed amount per service, averaged across 1,528 services

Providers submitted

$7452.75

Asking price, not received

Medicare allowed

$1317.55

The fee schedule figure

Medicare paid

$1052.32

Balance is patient coinsurance

Providers submitted an average of $7452.75 for this code and Medicare allowed $1317.55 — 5.7× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $1052.32 (80%); the rest is the patient’s coinsurance and deductible.

Services: 1,528
Beneficiaries: 1,501
Providers billing it: 92
Total allowed: $2,013,216

What Medicare pays for CPT 27280

Across 1,528 services billed by 92 providers to 1,501 beneficiaries, Medicare allowed an average of $1317.55 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 27280

Specialty	Services	Beneficiaries	Avg allowed	Providers
Orthopedic Surgery	693	683	$1515.39	39
Neurosurgery	532	517	$1645.16	32
Physician Assistant	236	234	$242.42	16
Nurse Practitioner	54	54	$219.24	4
Neurology	13	13	$1444.73	1

27280 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	239	$1494.50	$1137.98	13
Colorado	190	$1005.46	$804.35	10
Ohio	140	$1230.09	$987.09	7
Florida	133	$1633.96	$1118.91	9
Texas	122	$1262.20	$1014.42	9
Virginia	71	$1338.30	$1099.35	4
Maryland	62	$1438.48	$956.30	3
Missouri	49	$1139.69	$910.06	3
North Carolina	43	$1639.07	$1376.14	3
Kansas	42	$1014.45	$867.07	2
Idaho	41	$1135.10	$1016.88	3
Massachusetts	36	$1700.50	$1318.60	3
Alabama	36	$1063.07	$951.74	2
Nebraska	32	$858.67	$818.58	2
Oklahoma	32	$915.27	$788.74	2
District of Columbia	31	$2247.37	$1539.98	1
Delaware	30	$1370.36	$1098.40	2
Kentucky	29	$1655.20	$1365.62	2
Pennsylvania	28	$1209.72	$920.37	2
Wisconsin	25	$860.81	$848.31	2
Oregon	22	$1343.91	$1135.54	1
Rhode Island	19	$1352.24	$1080.96	1
Michigan	14	$1809.36	$1545.34	1
Tennessee	14	$1807.75	$1608.58	1
Indiana	12	$1218.21	$1030.84	1
Nevada	12	$151.46	$118.10	1
Georgia	12	$2092.01	$1608.28	1
New Jersey	12	$328.20	$234.45	1

Related codes

27245Treatment of broken neck of thigh bone$1034.24
27236Treatment of upper end of broken thigh bone$983.38
27279Fusion of pelvic joint$5445.92

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.