CPT 27279 · SI Fusion · Ambetter
SI Fusion — Minimally Invasive at Ambetter.
How Ambetter approaches CPT 27279 (SI Fusion — Minimally Invasive) for prior-authorization review: at last review on 2025-04-01, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2025-04-01
Policy number
CP.MP.126Criteria summary
High-level themes from the Ambetter policy of record for CPT 27279. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 24 weeks of conservative care typically required.
- Imaging concordance documentation required.
- Prior Two diagnostic intra-articular SIJ injections plus failed therapeutic SIJ injection (unless contraindicated) documentation required (typically with ≥75% relief).
See the full Ambetter criteria.
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