CPT 27279 · SI Fusion · BCBS New Mexico
SI Fusion — Minimally Invasive at BCBS New Mexico.
How BCBS New Mexico approaches CPT 27279 (SI Fusion — Minimally Invasive) for prior-authorization review: at last review on 2024-10-28, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2024-10-28
Policy number
MSK SIJ Fusion 2025-11-15Criteria summary
High-level themes from the BCBS New Mexico policy of record for CPT 27279. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 26 weeks of conservative care typically required.
- Imaging concordance documentation required.
- Prior Diagnostic intra-articular SI joint anesthetic block (image-guided, contrast-enhanced) documentation required (typically with ≥75% relief).
Source: Carelon Clinical Appropriateness Guidelines — Sacroiliac Joint Fusion
See the full BCBS New Mexico criteria.
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