Tampa – November 06, 2026 -- Medicare will pay a national non-facility (office) rate of approximately $19,441 for CPT code 27279 starting January 1, 2027, according to PainTEQ's reading of the CMS Calendar Year 2027 Physician Fee Schedule Final Rule (CMS-1848-F). The code covers percutaneous or minimally invasive sacroiliac (SI) joint arthrodesis using devices with intrinsic fixation that pierce the cortices. It had no office rate before that date.
CMS finalizes practice expense inputs that create the first office rate for 27279
Under the 2026 Physician Fee Schedule, code 27279 carried a facility payment rate only. For 2027, CMS finalized the RUC-recommended practice expense inputs, which produce the new office rate. The $19,441 figure is before geographic adjustment, sequestration and patient cost sharing, and actual payment varies by locality.
Facility payments for codes 27278 and 27279 move in different directions
Under the separate hospital outpatient and ambulatory surgery center (ASC) payment systems, hospital outpatient payment for codes 27278 and 27279 rose to approximately $20,022. ASC payment rose to approximately $15,794 for 27278 and $15,518 for 27279. The physician fee for both codes performed in a facility decreased modestly.
Office payment for 27278 has supported more than 1,000 posterior SI joint procedures
The 2024 Physician Fee Schedule established a non-facility rate for code 27278, which describes device placement without cortical piercing. Since then, more than 1,000 posterior SI joint procedures with PainTEQ products, including LINQ, have been performed in physician offices. PainTEQ says the 2027 rule extends a comparable office payment pathway to technologies reported under 27279, such as its TRAQ device, whose cortical broach pierces the lateral sacral cortex and medial iliac cortex.
Corey W. Hunter, MD, of the Montefiore Multidisciplinary Pain Program at Montefiore Einstein, said the distinction between the two codes depends on whether the device pierces the cortices and engages bone with its own fixation, not on the approach or the site of service.
Coverage remains a contractor decision despite the new payment rate
The fee schedule sets what Medicare pays when a service is covered and does not establish coverage. Existing local coverage determinations address code 27279, but the new office rate does not automatically create coverage in that setting. Medicare Advantage and commercial plans apply their own policies, and practices must confirm coverage and prior authorization requirements with each payer.
Douglas Beall, MD, interventional radiologist and Chief of Radiology Services at Clinical Radiology of Oklahoma, said office-based physicians now have a payment pathway for cortex-piercing procedures that previously required a hospital or surgery center. He added that the industry will be watching for contractor policies to catch up: "Coverage is still each contractor's decision."
PainTEQ's market access team is offering to help practices with site-of-service and prior authorization questions ahead of January.