CPT 27279 · SI Fusion · Premera Blue Cross
SI Fusion — Minimally Invasive at Premera Blue Cross.
How Premera Blue Cross approaches CPT 27279 (SI Fusion — Minimally Invasive) for prior-authorization review: at last review on 2026-01-12, the policy covers this code with prior authorization required.
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6.01.527Criteria summary
High-level themes from the Premera Blue Cross 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 SI joint anesthetic injection ×2 documentation required (typically with ≥75% relief).
Source: Premera Medical Policy 6.01.527 — Diagnosis and Treatment of Sacroiliac Joint Pain
See the full Premera Blue Cross criteria.
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