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HCPCS G0415 · Level II · G code

G0415: Open treatment of posterior pelvic bone fracture and/or dislocation, HCPCS Level II G code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file.

Key facts for G0415

Medicare payment
$1,239.17
PFS facility, national
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
1
MAI 2
OPPS status
SI J1
Hospital Part B services paid through a comprehensive APC
NCCI PTP pairs
246
191 hospital outpatient
LCDs and articles
0 / 0

TL;DR

CMS describes HCPCS G0415, added in 2009, as "Open treatment of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation, when performed (includes ilium, sacroiliac joint and/or sacrum)". National PFS payment for G0415 is no non-facility amount in an office and $1,239.17 in a facility (October 2026), built from 20.41 work, 12.26 practice-expense and 4.43 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $1,245.35 at $33.5675. Global period 090 (90-day global period). CMS caps G0415 at practitioner 1 (MAI 2, Anatomic Consideration); hospital outpatient 1 (MAI 2, Anatomic Consideration) units per day in the 2026 Q4 MUE tables. In the NCCI PTP files v323r0 G0415 appears in 0 practitioner pairs as column 2 and 246 as column 1, and in 0 hospital outpatient pairs as column 2 and 191 as column 1. G0415 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code C (carrier judgment, so the Medicare contractor decides coverage) and any NCD. HCPCS record: BETOS P3D (major procedure, orthopedic - other); pricing indicator 13; type of service 2 (surgery). Nearby codes: G0416, G0413, G0411, G0410.

G0415 descriptor and code status

The October 2026 HCPCS Level II file describes G0415 as “Open treatment of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation, when performed (includes ilium, sacroiliac joint and/or sacrum)”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes.

HCPCS file attributes of G0415
FieldValue
Short descriptorOpen tx post pelvic fxcture
Added to HCPCS2009-01-01
Last actionN (no maintenance), effective 2026-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator13: physician fee schedule, priced by the contractor
BETOS categoryP3D: major procedure, orthopedic - other
Type of service2: surgery

Medicare payment for G0415

National PFS payment for G0415 is no non-facility amount in an office and $1,239.17 in a facility (October 2026), built from 20.41 work, 12.26 practice-expense and 4.43 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $1,245.35 at $33.5675. Global period 090 (90-day global period). The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status A: active: paid separately under the physician fee schedule when covered. Global period 090 (90-day global period); PC/TC indicator 0 (physician service; the professional/technical split does not apply).

PFS relative values and national payment for G0415
ComponentNon-facilityFacility
Work RVU20.4120.41
Practice expense RVUNA12.26
Malpractice RVU4.434.43
Total RVUsNA37.10
National payment (CF $33.4009)n/a$1,239.17
Qualifying APM participant (CF $33.5675)n/a$1,245.35
  • Multiple procedures (modifier 51): standard multiple-procedure reduction (100%, then 50%)
  • Bilateral (modifier 50): 150% bilateral adjustment does not apply
  • Assistant at surgery: assistant at surgery may be paid; co-surgeons: co-surgeons permitted; team surgery: team surgeons not permitted
  • Physician supervision of diagnostic procedures: supervision concept does not apply

Hospital outpatient (OPPS Addendum B)

Status indicator J1 (Hospital Part B services paid through a comprehensive APC), APC 5113 (Level 3 Musculoskeletal Procedures), national unadjusted payment $3,342.87 with a minimum unadjusted copayment of $668.58.

Ambulatory surgical center (Addendum AA)

Payment indicator G2 (Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight), national rate $1,644.87 at a payment weight of 29.2047. The multiple-procedure discount applies when it is billed with another ASC procedure.

Medically Unlikely Edits for G0415

CMS caps G0415 at practitioner 1 (MAI 2, Anatomic Consideration); hospital outpatient 1 (MAI 2, Anatomic Consideration) units per day in the 2026 Q4 MUE tables. The practitioner MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.

MUE values for G0415 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services12 Date of Service Edit: PolicyAnatomic Consideration
Facility outpatient hospital12 Date of Service Edit: PolicyAnatomic Consideration

The MUE lookup for G0415 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, G0415 is the column-2 (bundled) code in 0 active pairs and the column-1 code in 246 (76% modifier-allowed); 79 earlier pairs have been deleted.

Column-2 codes bundled into G0415 (practitioner)
Column-2 codePairs
0213T (CPT; descriptor licensed by AMA)1
0216T (CPT; descriptor licensed by AMA)1
0596T (CPT; descriptor licensed by AMA)1
0597T (CPT; descriptor licensed by AMA)1
0708T (CPT; descriptor licensed by AMA)1
0709T (CPT; descriptor licensed by AMA)1
0903T (CPT; descriptor licensed by AMA)1
0904T (CPT; descriptor licensed by AMA)1

In the hospital outpatient PTP file v323r0, G0415 is the column-2 (bundled) code in 0 active pairs and the column-1 code in 191 (98% modifier-allowed); 28 earlier pairs have been deleted.

Column-2 codes bundled into G0415 (hospital outpatient)
Column-2 codePairs
0213T (CPT; descriptor licensed by AMA)1
0216T (CPT; descriptor licensed by AMA)1
0596T (CPT; descriptor licensed by AMA)1
0597T (CPT; descriptor licensed by AMA)1
0708T (CPT; descriptor licensed by AMA)1
0709T (CPT; descriptor licensed by AMA)1
0903T (CPT; descriptor licensed by AMA)1
0904T (CPT; descriptor licensed by AMA)1

G0415 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check G0415 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0415

No current LCD or billing and coding article lists G0415. The HCPCS coverage code C means carrier judgment, so the Medicare contractor decides coverage, and any National Coverage Determination for the service still applies.

Denials to expect on G0415

CARC 50 · N115

the service is not reasonable and necessary for the diagnosis on the claim

CARC 151 · N362

units of G0415 exceed the practitioner MUE of 1 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks the description, invoice or pricing detail a contractor-priced code needs

Where QuickIntell fits for G0415 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0415 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS G0415

What does HCPCS code G0415 describe?

"Open treatment of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation, when performed (includes ilium, sacroiliac joint and/or sacrum)" (short descriptor "Open tx post pelvic fxcture"), in the G section (procedures and professional services, temporary). Added 2009-01-01; last action N (no maintenance) effective 2026-01-01.

Is G0415 a CPT code?

It is not. G0415 belongs to the G section (procedures and professional services, temporary) of HCPCS Level II, the CMS code set, not to AMA CPT.

What does Medicare pay for G0415?

National PFS payment for G0415 is no non-facility amount in an office and $1,239.17 in a facility (October 2026), built from 20.41 work, 12.26 practice-expense and 4.43 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $1,245.35 at $33.5675. Global period 090 (90-day global period).

How many units of G0415 can be billed per day?

CMS caps G0415 at practitioner 1 (MAI 2, Anatomic Consideration); hospital outpatient 1 (MAI 2, Anatomic Consideration) units per day in the 2026 Q4 MUE tables. For the practitioner MUE (MAI 2), units above 1 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover G0415?

G0415 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code C (carrier judgment, so the Medicare contractor decides coverage) and any NCD.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.