CPT 27279 · SI Fusion · Simply Healthcare Plans (Anthem/Elevance) — Florida Medicaid
SI Fusion — Minimally Invasive at Simply Healthcare Plans (Anthem/Elevance) — Florida Medicaid.
How Simply Healthcare Plans (Anthem/Elevance) — Florida 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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Carelon MSK05-0424.2 / Anthem SURG.00096 (delegated to Carelon)Criteria summary
High-level themes from the Simply Healthcare Plans (Anthem/Elevance) — Florida 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 contrast-enhanced intra-articular SI joint injection (diagnostic) on TWO separate occasions documentation required (typically with ≥75% relief).
Source: Carelon Appropriate Use Criteria — Sacroiliac Joint Fusion
See the full Simply Healthcare Plans (Anthem/Elevance) — Florida Medicaid criteria.
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