CPT 27280 · SI Fusion · Medicare (Noridian JF MAC)
SI Fusion — Open at Medicare (Noridian JF MAC).
How Medicare (Noridian JF MAC) approaches CPT 27280 (SI Fusion — Open) for prior-authorization review: at last review on 2026-04-26, the policy covers this code without prior authorization.
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Coverage
Covered
Prior auth
No prior auth
Last reviewed
2026-04-26
Policy number
Clearway-MPG-SIFusionCriteria summary
High-level themes from the Medicare (Noridian JF MAC) 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).
Source: Clearway Master Payer Guidelines v2025 — SI Fusion
See the full Medicare (Noridian JF MAC) criteria.
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