CPT 27280 · SI Fusion
SI Fusion — Open
Arthrodesis, open, sacroiliac joint, including obtaining bone graft, with or without instrumentation.
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Rubrica tracks payor coverage for CPT 27280 (SI Fusion — Open) across 104 payors — every Medicare MAC, the major commercial plans, the BCBS family, all 50-state Medicaid programs, and selected workers' comp and auto/PIP carriers. Aggregate coverage patterns are shown below; full payor-specific criteria, source citations, and last-reviewed dates are available to signed-in practitioners.
Top payors covering CPT 27280
Sample of 12 payors with coverage for this code. Sign in for the complete payor list, verbatim criteria, denial-risk score, and source citations for each.
| Payor | Coverage | Prior auth |
|---|---|---|
| Aetna | Covered | Prior auth |
| Aetna Better Health Medicaid | Covered | Prior auth |
| Aetna Better Health of Florida | Covered | Prior auth |
| Aetna Better Health of Maryland | Covered | Prior auth |
| Aetna Better Health of New Jersey | Covered | Prior auth |
| Aetna Medicare Advantage | Covered | Prior auth |
| Alabama Medicaid | Covered | Prior auth |
| Alabama Medicaid (FFS) | Covered | Prior auth |
| Allstate Auto / PIP | Covered | Prior auth |
| AmTrust Financial WC | Covered | Prior auth |
| Ambetter | Covered | Prior auth |
| AmeriHealth Caritas | Covered | Prior auth |
Coverage themes for CPT 27280
Common patterns across the 104 payors we track. Specific criteria per payor are available after sign-in.
Most payors require ≥26 weeks of conservative care before approving 27280.
68 of 104 payors require imaging concordance documentation.
Of the 104 payors with coverage records for CPT 27280, 71 require prior authorization, 33 cover without prior authorization, and 0 flag the procedure as investigational or experimental under current criteria.
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