CPT 27279 · SI Fusion · Medicare (Palmetto GBA MAC)
SI Fusion — Minimally Invasive at Medicare (Palmetto GBA MAC).
How Medicare (Palmetto GBA MAC) approaches CPT 27279 (SI Fusion — Minimally Invasive) for prior-authorization review: at last review on 2026-04-15, the policy covers this code with prior authorization required.
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L39025Criteria summary
High-level themes from the Medicare (Palmetto GBA MAC) 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 (image-guided) with ≥50% concordant relief on two separate occasions documentation required (typically with ≥50% relief).
Source: LCD - Minimally Invasive Surgical (MIS) Fusion of the Sacroiliac Joint (SIJ) (L39025)
See the full Medicare (Palmetto GBA MAC) criteria.
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