CPT 27279 · SI Fusion · Medicare (Novitas MAC) — TX
SI Fusion — Minimally Invasive at Medicare (Novitas MAC) — TX.
How Medicare (Novitas MAC) — TX approaches CPT 27279 (SI Fusion — Minimally Invasive) for prior-authorization review: at last review on 2026-04-26, the policy covers this code without prior authorization.
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Coverage
Covered
Prior auth
No prior auth
Last reviewed
2026-04-26
Policy number
Clearway-MPG-SIFusionCriteria summary
High-level themes from the Medicare (Novitas MAC) — TX 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 SIJ injection (anesthetic only) documentation required (typically with ≥75% relief).
Source: Clearway Master Payer Guidelines v2025 — SI Fusion
See the full Medicare (Novitas MAC) — TX criteria.
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