PainTEQ Highlights CMS 2027 Physician Fee Schedule Establishes Non-Facility (Office) Payment Rate for CPT Code 27279

Effective January 1, 2027, Medicare has established a non-facility (office) payment rate for CPT code 27279, creating an office payment pathway for procedures reported with that CPT code, including posterior SI joint procedures

TAMPA, Fla., Nov. 5, 2026 — PainTEQ today highlighted a change in the Centers for Medicare & Medicaid Services (CMS) Calendar Year 2027 Physician Fee Schedule Final Rule (CMS-1848-F) that establishes a non-facility (office) payment rate for CPT code 27279, the code used to report percutaneous or minimally invasive sacroiliac (SI) joint arthrodesis with placement of transarticular and/or intra-articular device(s) that engage bone with intrinsic fixation (e.g., screw[s], flange[s], blade[s]) piercing the lateral cortex of the sacrum and 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. Effective January 1, 2027, the national non-facility (office) payment amount for CPT code 27279 will be approximately $19,441. Prior to January 1, 2027, CPT code 27279 did not have a non-facility (office) payment rate.

The CY 2027 Medicare payment rules set what Medicare pays for the calendar year; whether a procedure is covered remains subject to applicable national and local Medicare coverage policies, as well as individual health plan requirements.

Founded in 2013 and headquartered in Tampa, Florida, PainTEQ develops minimally invasive solutions for chronic pain, including SI joint dysfunction, and helped pioneer posterior SI joint procedures with its LINQ^® and TRAQ™ products. In 2024, the Physician Fee Schedule established a non-facility (office) payment rate for CPT code 27278, which describes placement without cortical piercing. Since that time, more than 1,000 posterior SI joint procedures with PainTEQ products (e.g. LINQ^®) have been performed in physician offices. The 2027 rule extends a comparable office payment pathway for technologies that are used in SI joint procedures reported with CPT code 27279.

Physicians and practice administrators can find reimbursement resources and reach PainTEQ's market access team at painteq.com/clinician.

What changed

• Under the 2026 Physician Fee Schedule, CPT code 27279 had a facility payment rate only; no non-facility (office) payment rate was established.
• For 2027, CMS finalized the RUC-recommended practice expense inputs for CPT code 27279, creating a national non-facility (office) payment rate of approximately $19,441.
• Under the separate hospital outpatient and ambulatory surgery center payment systems, hospital outpatient payment for CPT codes 27278 and 27279 increased to approximately $20,022, and ambulatory surgery center payment increased to approximately $15,794 for 27278 and $15,518 for 27279.
• The physician's fee for CPT codes 27278 and 27279 performed in a facility decreased modestly.

"With the 2027 CPT revision, the line between CPT codes 27278 and 27279 is whether the device placed pierces the cortices and engages bone with its own fixation. It is not about the approach, and it has never been about where the procedure is performed," said Corey W. Hunter, MD, of the Montefiore Multidisciplinary Pain Program at Montefiore Einstein in New York. "Creating a non-facility (office) payment rate for CPT code 27279 finally brings the fee schedule in line with the code."

"Office-based labs have handled complex interventional pain procedures for years, but until now, a procedure that pierced the cortices (CPT code 27279) meant sending the patient to a hospital or surgery center," said Douglas Beall, MD, interventional radiologist and Chief of Radiology Services at Clinical Radiology of Oklahoma. "For the first time, physicians who practice in that setting have a payment pathway. Coverage is still each contractor's decision, and we'll all be watching for their policies to catch up."

PainTEQ's market access team is available to help practices work through site-of-service and prior authorization questions ahead of January.

Frequently Asked Questions

How much does Medicare pay for CPT code 27279 in the office in 2027?

CMS established a non-facility (office) payment rate for CPT code 27279 in the Calendar Year 2027 Physician Fee Schedule final rule. Starting January 1, 2027, the national non-facility (office) payment amount for CPT code 27279 is approximately $19,441, before geographic adjustment, sequestration, and patient cost sharing. In 2026 the code had no non-facility (office) payment rate. Actual payment varies by locality.

Does this mean Medicare now covers SI joint fusion in the office?

No. The fee schedule sets what Medicare pays when a service is covered; it does not indicate coverage. Coverage for CPT code 27279 remains subject to applicable Medicare Administrative Contractor (MAC) coverage policies and medical necessity requirements. While existing LCDs address coverage for CPT code 27279, the establishment of a non-facility (office) payment rate does not automatically establish coverage in that setting. Medicare Advantage and commercial plans apply their own policies. Practices should confirm coverage and prior authorization requirements with each payer before scheduling procedures.

What does CPT code 27278 describe effective January 1, 2027?

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

What does CPT code 27279 describe effective January 1, 2027?

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

Which PainTEQ products are placed without cortical piercing?

LINQ^® is placed within the sacroiliac joint through a posterior approach and does not pierce the cortices of the sacrum or ilium.

Which PainTEQ products pierce the cortices?

TRAQ™ is placed within the sacroiliac joint through the same posterior approach, with one additional step: a cortical broach pierces the lateral cortex of the sacrum and the medial cortex of the ilium, and TRAQ's intrinsic fixation barbs are designed to engage that cortical bone.

Disclaimer

The information in this release is general reimbursement information gathered from third-party sources and is subject to change. It is not legal, coding, or billing advice and is not intended to increase or maximize reimbursement by any payer. PainTEQ does not recommend or require the use of any particular code, product, or site of service. The treating physician is solely responsible for determining medical necessity and the appropriate site of service based on each patient's clinical needs, and for selecting codes that accurately describe the procedure actually performed and documented in the medical record. Payment amounts are unadjusted national averages; actual payment will vary. A payment rate does not mean a service is covered. PainTEQ does not guarantee coverage or payment. Providers should verify current requirements with each payer and consult their own legal counsel or reimbursement advisors.

Safety Information

LINQ^® is a human cell, tissue, and cellular and tissue-based product (HCT/P) regulated solely under Section 361 of the PHS Act and 21 CFR Part 1271. Refer to the package insert for warnings and precautions. Please refer to the labeling for complete instructions for use. LINQ^® is processed by RTI Surgical, Inc.

TRAQ™ is a human cell, tissue, and cellular and tissue-based product (HCT/P) regulated solely under Section 361 of the PHS Act and 21 CFR Part 1271. Refer to the package insert for warnings and precautions. Please refer to the labeling for complete instructions for use. TRAQ™ is processed by Berkeley Advanced Biomaterials.

SOURCE PainTEQ