CPT 27280 · SI Fusion · UnitedHealthcare Community Plan of Pennsylvania
SI Fusion — Open at UnitedHealthcare Community Plan of Pennsylvania.
How UnitedHealthcare Community Plan of Pennsylvania 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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UHC CP-PA Provider ManualCriteria summary
High-level themes from the UnitedHealthcare Community Plan of Pennsylvania 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 block (CPT 27096) documentation required (typically with ≥75% relief).
Source: UnitedHealthcare Community Plan of Pennsylvania — Care Provider Manual (HealthChoices, 2025/2026)
See the full UnitedHealthcare Community Plan of Pennsylvania criteria.
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