CPT 27280 · SI Fusion · Sunshine Health (Centene) — Florida Medicaid
SI Fusion — Open at Sunshine Health (Centene) — Florida Medicaid.
How Sunshine Health (Centene) — Florida Medicaid 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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CP.MP.126Criteria summary
High-level themes from the Sunshine Health (Centene) — Florida Medicaid 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 SI joint injection under fluoroscopy documentation required (typically with ≥75% relief).
Source: Centene CP.MP.126 (Sacroiliac Joint Fusion) — adopted by Sunshine Health FL Medicaid
See the full Sunshine Health (Centene) — Florida Medicaid criteria.
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