CPT 27279 · SI Fusion · Medicare (Novitas MAC)
SI Fusion — Minimally Invasive at Medicare (Novitas MAC).
How Medicare (Novitas MAC) approaches CPT 27279 (SI Fusion — Minimally Invasive) for prior-authorization review: at last review on 2026-05-09, the policy covers this code with prior authorization required.
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Criteria summary
High-level themes from the Medicare (Novitas MAC) 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 SI injections (27096) with ≥75% pain relief on each documentation required (typically with ≥75% relief).
Source: Novitas — 27279 governed by Medicare CPT/PA list (operates without a stand-alone Novitas LCD)
See the full Medicare (Novitas MAC) criteria.
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