CPT 27280 · SI Fusion · Priority Partners MCO
SI Fusion — Open at Priority Partners MCO.
How Priority Partners MCO approaches CPT 27280 (SI Fusion — Open) for prior-authorization review: at last review on 2026-04-27, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2026-04-27
Policy number
eviCore Spine Surgery (SIJ fusion)Criteria summary
High-level themes from the Priority Partners MCO policy of record for CPT 27280. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 24 weeks of conservative care typically required.
- Imaging concordance documentation required.
- Prior Two diagnostic SIJ injections (intra-articular) with concordant relief documentation required (typically with ≥75% relief).
Source: JHHC / eviCore Spine Surgery — Sacroiliac Joint Fusion (Priority Partners)
See the full Priority Partners MCO criteria.
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