CPT 27280 · SI Fusion · UnitedHealthcare Medicare Advantage
SI Fusion — Open at UnitedHealthcare Medicare Advantage.
How UnitedHealthcare Medicare Advantage approaches CPT 27280 (SI Fusion — Open) for prior-authorization review: at last review on 2026-04-26, the policy covers this code with prior authorization required.
Free with practitioner sign-in — magic-link email auth, no credit card.
Clearway-MPG-SIFusionCriteria summary
High-level themes from the UnitedHealthcare Medicare Advantage 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 UnitedHealthcare Medicare Advantage criteria.
Sign in for verbatim conservative-care language, exact imaging-concordance rules, repeat-procedure thresholds, and the denial-risk score for any specific clinical scenario.
Sign in — free for practitioners →