- Taylor Headley
  Project Manager, Executive Council, KIC Ventures 

As minimally invasive techniques for sacroiliac (SI) joint fusion continue to evolve, the American Medical Association (AMA) has taken a major step in recognizing these advances through the recent addition of CPT code 27278. This new classification acknowledges a growing body of procedural innovation—particularly those that avoid transfixation and focus on intra-articular stabilization. 

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Differentiating Technique Through Code 

CPT 27278 defines SI joint fusion as: 

“Arthrodesis, sacroiliac joint, percutaneous, with image guidance, including placement of intra-articular implant(s)... without placement of transfixation device.” 

This precise language reflects a newer class of procedures that stabilize the SI joint without using implants that cross from the ilium into the sacrum. In contrast, CPT 27279 continues to describe traditional transfixation techniques. 

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By clearly differentiating intra-articular from transfixation-based fusion, the AMA’s update aligns coding structure with contemporary practice—giving researchers and clinicians better tools for reporting outcomes based on procedural nuance. 

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What This Means for Innovation in Spine & Orthobiologics 

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The distinction between these codes isn’t just administrative—it’s clinical. It reinforces that procedural technique matters, and that more anatomic, joint-preserving approaches are gaining formal recognition. For companies innovating around biologics, graft materials, and precision-guided tools, CPT 27278 may mark the beginning of a more granular and clinically validated era of SI joint fusion. 

Looking Ahead 

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In May 2025, the AMA Editorial Panel approved guideline revisions for both CPT 27278 and 27279, set to take effect in January 2027. These changes will likely further support researchers looking to stratify data by surgical technique and refine best practices. 

The Takeaway 

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For those studying or developing minimally invasive SI joint fusion systems, CPT 27278 represents more than a code—it’s a milestone in how the field is evolving. As data continues to accumulate, the ability to differentiate and document intra-articular fusion techniques will become essential in demonstrating value, safety, and clinical superiority.