CPT 27279 · SI Fusion · Horizon NJ Health — NJ Medicaid
SI Fusion — Minimally Invasive at Horizon NJ Health — NJ Medicaid.
How Horizon NJ Health — NJ Medicaid approaches CPT 27279 (SI Fusion — Minimally Invasive) for prior-authorization review: at last review on 2026-05-06, the policy covers this code with prior authorization required.
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139Criteria summary
High-level themes from the Horizon NJ Health — NJ Medicaid 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 Image-guided diagnostic SI joint anesthetic injection ×2 + therapeutic corticosteroid injection trial documentation required (typically with ≥75% relief).
Source: Horizon BCBSNJ Medical Policy 139 — Sacroiliac Joint Fusion/Stabilization
See the full Horizon NJ Health — NJ Medicaid criteria.
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