CPT 27280 · SI Fusion · Highmark Wholecare — PA HealthChoices
SI Fusion — Open at Highmark Wholecare — PA HealthChoices.
How Highmark Wholecare — PA HealthChoices approaches CPT 27280 (SI Fusion — Open) for prior-authorization review: at last review on 2026-05-06, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2026-05-06
Policy number
HealthHelp MSK Surgery — Sacroiliac Joint FusionCriteria summary
High-level themes from the Highmark Wholecare — PA HealthChoices 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 Two diagnostic SIJ injections (CPT 27096 / G0260) documentation required (typically with ≥75% relief).
See the full Highmark Wholecare — PA HealthChoices criteria.
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