CPT 27280 · SI Fusion · Aetna Medicare Advantage
SI Fusion — Open at Aetna Medicare Advantage.
How Aetna Medicare Advantage approaches CPT 27280 (SI Fusion — Open) for prior-authorization review: at last review on 2026-05-08, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2026-05-08
Policy number
Clearway-MPG-SIFusionCriteria summary
High-level themes from the Aetna Medicare Advantage policy of record for CPT 27280. 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).
See the full Aetna Medicare Advantage criteria.
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